Behavioral and Psychological Symptoms of Dementia

Abstract

Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis, and treatment response may be useful in the clinical practice. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social, and biological factors. Recent studies have emphasized the role of neurochemical, neuropathological, and genetic factors underlying the clinical manifestations of BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes associated with BPSD.

Emerging Technologies for Monitoring Behavioural and Psychological Symptoms of Dementia

“…BPSD are a source of significant distress and poor quality of life (QoL) to both individuals with dementia as well as their carers [2], [3]. They are associated with increased mortality rate and rapid deterioration of cognition [2], [4], [5]. Moreover, they are major reason for early institutionalisation of patients [6], which in turn significantly increases the overall cost of dementia [7].…”

“…BPSD are a source of significant distress and poor quality of life (QoL) to both individuals with dementia as well as their carers [2], [3]. They are associated with increased mortality rate and rapid deterioration of cognition [2], [4], [5].…”

“…Behavioural and psychological symptoms of dementia (BPSD) are a heterogeneous group of clinical phenomena that is characterised by disturbed emotions, mood, perception, thought, motor activity, diurnal rhythm and altered personality traits [1], [2]. BPSD are a source of significant distress and poor quality of life (QoL) to both individuals with dementia as well as their carers [2], [3].…”

The South West Local Health Integration Network Behavioural Supports Ontario Experience

“…Referred to as responsive behaviours, behavioural and psychological symptoms can include aggression, disruptive behaviours, disinhibition, apathy, depression, anxiety and agitation (Cerejeira et al 2012;Patterson et al 1999;Savva et al 2009). These behaviours are a means of communication and reflect a response to something in the person's environment (Cohen-Mansfield 2000; Kunik et al 2010).…”

Amisulpride in Refractory Behavioral and Psychological Symptoms of Dementia

“…Psychosis is the most common disturbance in patients with dementias with behavioral and psychological symptoms of dementia (BPSD) [5], which affects up to 90% of all dementia subjects [6]. Psychotic BPSD include verbal and physical aggression, agitation, hallucinations delusions, irritability, sleep disturbances, oppositional behaviors, and wandering type behaviors [7] etc. Course of dementias is complicated by the occurrence of BPSD [1] and is the single most predictor of hospitalization and caregiver stress [5].…”