Nonpharmacological Management of Behavioral and Psychological Symptoms of Dementia: What Works, in What Circumstances, and Why?

Abstract

ObjectiveBehavioral and psychological symptoms of dementia (BPSD) refer to the often distressing, noncognitive symptoms of dementia. BPSD appear in up to 90% of persons with dementia and can cause serious complications. Reducing the use of antipsychotic medications to treat BPSD is an international priority. This review addresses the following questions: What nonpharmacological interventions work to manage BPSD? And, in what circumstances do they work and why?MethodA realist review was conducted to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases for empirical studies that reported a formal evaluation of nonpharmacological interventions to decrease BPSD.ResultsSeventy-four articles met the inclusion criteria. Three mechanisms emerged as necessary for sustained effective outcomes: the caring environment, care skill development and maintenance, and individualization of care. We offer hypotheses about how different contexts account for the success, failure, or partial success of these mechanisms within the interventions.DiscussionNonpharmacological interventions for BPSD should include consideration of both the physical and the social environment, ongoing education/training and support for care providers, and individualized approaches that promote self-determination and continued opportunities for meaning and purpose for persons with dementia.

An individualised, non-pharmacological treatment strategy associated with an improvement in neuropsychiatric symptoms in a man with dementia living at home

“…There are international efforts to promote the use of non-pharmacological interventions as first-line treatment for neuropsychiatric symptoms of dementia,3 9 33 supported by a growing body of evidence for benefit 3 6 8–10 12. However, most of the studies assessed focus on patients in long-term care facilities rather than community-based or home-based strategies.…”

“…With the escalating global challenge of caring for 132 million people with dementia worldwide by 2050,1 and no current pharmacological cure, there is a significant need for further research and innovative solutions for dementia care,2 especially for people who would prefer to remain in their own home. In addition to cognitive symptoms, the neuropsychiatric symptoms of dementia, also known as behavioural and psychological symptoms of dementia, occur in >90% of people with dementia 3–6. These neuropsychiatric symptoms include agitation, aggression, apathy, depression, elation, disinhibition, anxiety, irritability, sleep disturbances, wandering, repetitive questioning, delusions, hallucinations and psychosis 3 4 7–10.…”

“…In addition to cognitive symptoms, the neuropsychiatric symptoms of dementia, also known as behavioural and psychological symptoms of dementia, occur in >90% of people with dementia 3–6. These neuropsychiatric symptoms include agitation, aggression, apathy, depression, elation, disinhibition, anxiety, irritability, sleep disturbances, wandering, repetitive questioning, delusions, hallucinations and psychosis 3 4 7–10. Neuropsychiatric symptoms are often distressing and can result in early institutionalisation, diminished quality of life, increased frequency of emergency department visits along with stress and ill-health in caregivers 3 4 7–10…”

“…Non-pharmacological interventions are recommended as first-line treatment for neuropsychiatric symptoms, instead of medications such as atypical antipsychotics which have significant associated side effects including stroke and death 11. While there have been several systematic reviews of the use of non-pharmacological interventions for the treatment of neuropsychiatric symptoms of dementia,3 6 8–10 12 most of the studies assessed focus on patients in long-term care facilities. There are a limited number of studies assessing the use of non-pharmacological treatment strategies for neuropsychiatric symptoms for patients living at home which focus on potential triggers of patient behaviours and behaviour modification strategies,13 interventions around environment and patient capabilities14 and tailored activities delivered by occupational therapists and nurses 15.…”

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

“…Caspar et al [29] divided non-pharmacologic treatment alternatives in indirect interventions when being targeted to the caregivers and multidisciplinary treatment teams, and direct interventions when strategies are directed to the patient. During the last few years, there have been several studies looking at different non-pharmacologic strategies in both direct and indirect domains.…”