Academic journal article Indian Journal of Psychiatry

Behavioral and Psychological Symptoms of Dementia and Their Management

Academic journal article Indian Journal of Psychiatry

Behavioral and Psychological Symptoms of Dementia and Their Management

Article excerpt

Byline: Nilamadhab. Kar

Purpose: Behavioral and psychological symptoms of dementia (BPSD) are an integral part of dementia syndrome. They increase morbidity and burden, affect quality of life and impact cost of care. This review aims to study the features of BPSD, their assessment and management.

Collection and Analysis of Data: Literature of BPSD was searched in PUBMED and the relevant cross references were accessed. Conclusions: Available literature suggests that BPSD can manifest in multiple ways; the common components are of behavioral, affective, psychotic and somatic in nature. There are specific rating scales for assessing BPSD; however, there is need for developing cross-culturally validated instruments. Nonpharmacological interventions are preferred as first line, which mainly include environmental modification, social interactions, minimizing effect of sensory deficits and behavioral interventions. The judicious use of medications such as cognitive enhancers, atypical antipsychotics and antidepressants has been suggested in acute, emergent situations or when BPSD do not respond to other interventions. There is a research need to address etiologies, social and economic impact of BPSD, efficacy of pharmacological and nonpharmacological treatments and cost-effectiveness of these interventions.

Introduction

Behavioral changes, paranoid delusions, hallucinations and long periods of screaming were described by Alzheimer in 1907 in his original case description of the disease.[sup] [1]

Behavioral and psychological symptoms of dementia (BPSD) are an integral part of dementia syndrome. Decline in emotional control or motivation, or a change in social behavior manifesting as emotional lability, irritability, apathy and coarsening of social behavior have been a part of diagnostic criteria for dementia.[sup] [2] Studies suggest that cognition and behavior are independent dimensions.[sup] [3] However, they influence each other; BPSD is associated with a more rapid rate of cognitive decline and greater impairment in activities of daily living;[sup] [4] and there are variations in severity of BPSD at different cognitive levels.[sup] [5] BPSD are often the reasons for the first contact with health professionals and hospitalization.[sup] [6] BPSD impact patient functioning and lead to premature transition to structured living environments and institutionalization.[sup] [7],[8],[9],[10] They are a cause of concern and burden to the caregivers; and are often more difficult to cope with than cognitive changes.[sup] [11] These symptoms are a major cause of diminished quality of life for both patients and care givers.[sup] [12],[13] BPSD contribute significantly to the overall costs of dementia care.[sup] [9],[14],[15] These noncognitive abnormalities which increase the morbidity of patients and burden of caregivers are mostly treatable. Their assessment and management are essential components of the treatment of dementia.[sup] [10] Periodic assessment of these symptoms can measure the effectiveness of interventions in dementia.[sup] [1],[16] This review aims to study the features of BPSD, their assessment and management. Literature of BPSD was searched in PUBMED and the relevant cross references were accessed.

Prevalence

In cross-sectional studies, reported prevalence of BPSD ranges from 50%-100%.[sup] [9],[17] Lifetime risk of neuropsychiatric disturbances is nearly 100%.[sup] [18] In a study assessing severity, BPSD were severe in 36.6% of the patients, moderate in 49.3%, and mild in 14.1%.[sup] [19] Different types of BPSD have been reported in varying frequencies considering the type and degree of dementia, number of BPSD studied, environmental parameters and instrument used. Depression is usually the most common, which affects more than half of the patients.[sup] [20],[21] However, apathy has also been found as the most common abnormality in some studies followed by anxiety and dysphoria. …

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