Assessment and management of behavioral and psychological symptoms of dementia.
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.
Section of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA kales@umich.edu.
Helen C
HC
Kales
Department of Community Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA Division of Geriatrics and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA.
Laura N
LN
Gitlin
Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD, USA.
Constantine G
CG
Lyketsos
D000374:Aggression / Q000523:psychology; D057565:Apathy; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D055816:Wandering Behavior / Q000523:psychology