Best practice in the management of behavioural and psychological symptoms of dementia

Abstract

Behavioural and psychological symptoms of dementia (BPSD) occur in most patients with dementia. They cause great suffering in patients and caregivers, sometimes more so than the cognitive and functional decline inherent to dementia. The clinical features of BPSD include a wide variety of affective, psychotic and behavioural symptoms and signs. The causes and risk factors for BPSD are multiple and include biological, psychological and environmental variables. Frequently, their combination, rather than any specific factor, explains the occurrence of BPSD in an individual patient. Thus, a sound etiopathogenetic investigation including the patient and the family or care team is essential. The aim is to develop an individualized treatment plan using a therapeutic decision tree modified by the individual and environmental risk profile. Still, treatment may be difficult and challenging. Clinical empiricism often steps in where evidence from controlled studies is lacking. Psychosocial treatment approaches are pivotal for successful treatment of BPSD. Often a combination of different non-pharmacological approaches precedes drug treatment (most of which is off-label). Regular assessments of the treatment plan and any prescriptions must be carried out to detect signs of relapse and to stop any medicines that may have become inappropriate. Even with optimal management, BPSD will not disappear completely in some cases and will remain challenging for all involved parties. This article is a narrative review based closely on the interprofessional Swiss recommendations for the treatment of BPSD. To establish the recommendations, a thorough research of the literature has been carried out. Evidence-based data were provided through searches of Medline, Embase, ISI and Cochrane-Database research. Evidence categories of the World Federation of Biological Societies were used. Additionally, the clinical experience of Swiss medical experts was considered.

Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review

“…In a recent meta‐analysis, the interventions for caregivers are unnumbered as education, training, counseling, support groups, stress management, exercise and health promotion, computerized telephone system, role play, environmental modification, practice, and schedule engagement in pleasant activities. It was reported that all these interventions have positive effect on caregiver distress, by improving their depression, health, burden, and social support and that of them, counseling, support group, education, stress and mood management, or telephone support that are significantly effective interventions . Zimmerman et al have also showed that educational resources, focusing on care of comorbidities of patients with dementia, might be useful for family caregiver outcomes .…”

Phenomenological contribution to understanding of vocally disruptive behaviour: A clinical case study in a patient with dementia

“…Furthermore, she had major depressed features as expressed by a MADRS score of 48. Indeed, a history of depressive disorder is likely to increase the risk of major depressive disorder during dementia …”

“…Specialized care teams propose to evaluate VDB looking for possible causes such as organic pain, psychosis, depression, or specific environmental factors or unmet needs that can trigger shouting. In fact, using an aetiological investigation, they propose to search for a direct organic, psychological, or environmental cause prompting a number of psychological and environmental interventions …”

“…We propose to understand vocally disruptive behaviour (VDB), a form of behavioural and psychological symptoms of dementia (BPSD), within the frame of a phenomenological diagnosis considering each subject as unique. A complete clinical examination is necessary to optimize individualized treatment . Conceptually, we refer to the phenomenologists Tatossian and Heidegger .…”

Phenomenological Understanding of Behavioural and Psychological Symptoms of Dementia: A Clinical Case Presenting Howls and Shouting. The Melancholic Type and Phenomenology of Separation

“…Thus, we propose to understand behavioural and psychological symptoms of dementia, and to review each subject as unique, in order to determine the diagnosis with a phenomenological approach. A complete clinical examination is also necessary, for an optimal individualized treatment, already recommended recently by specialized teams [2]. This scientific idea, to have a phenomenological approach in psychiatry, was proposed by the phenomenologists Tatossian and Heidegger to be able to pass from a clinical case to the theory [1,[3][4][5].…”