Management of Neuropsychiatric Symptoms of Dementia: A Comprehensive Review of the Current Literature

Abstract

Background: Dementia is a progressive and debilitating condition that affects millions of patients in the United States with an enormous impact on healthcare costs, caregivers, and society. Patients with dementia often experience dementia-related neuropsychiatric disturbances, commonly known as Behavioral and Psychological Symptoms of Dementia (BPSD) and more recently Neuropsychiatric symptoms (NPS) in dementia. These symptoms include verbal and physical agitation, aggression, disinhibition, affect lability, apathy, psychosis, depression, and anxiety. Symptom management is important to optimize quality of life, minimize further functional decline, and delay institutionalization. We aim to review the existing published literature on pharmacologic and non-pharmacologic management of NPS. Methods: PubMed, Google Scholar, and Cochrane were searched for available reviews, systematic reviews, meta-analysis, and randomized controlled trials on diagnostic tools and treatment strategies for NPS. Some of the searched terms used included, "neuropsychiatric symptoms of dementia treatment," "NPS treatment," "pharmacologic treatment NPS," "non-pharmacologic treatment NPS," "scales NPS." We also searched for the term "BPSD" instead of "NPS" and "neurocognitive disorder" instead of "dementia." Recent Findings: There are different treatment modalities to address NPS, including pharmacologic and non-pharmacologic approaches, but the evidence throughout the years has been controversial and mostly studied in Alzheimer's disease population making less generalizable to other dementia populations. Summary: NPS continues to be a prevalent and debilitating condition in the elderly population with dementia. Non-pharmacologic strategies continue to be the first-line treatment for NPS despite lack of strong evidence because of their potential benefit and absence of side effects. Conversely, pharmacologic strategies have a potential risk for side effects in addition to the lack of strong evidence about their benefits in NPS; therefore, deprescribing is an important consideration in the management of these patients.