Home

Loading...

Table of contents

Behavioral and psychological symptoms of dementia

What's new

Updated 2024 CCSMH guidelines for the assessment and management of behavioral and psychological symptoms of dementia.

Background

Overview

Definition
BPSD is a heterogeneous range of psychological reactions, psychiatric symptoms, and behaviors occurring in people with dementia of any etiology.
1
Pathophysiology
BPSD are caused due to a complex interplay of psychological, social, and biological factors including neurochemical, neuropathological and genetic factors.
2
Disease course
The complex interaction of psychosocial and biological factors results in BPSD, which have clinical manifestations of agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. Disease progression is associated with poor QoL, distress among patients and caregivers, long-term hospitalizations, medication misue,a nd increased health-care costs.
2
Prognosis and risk of recurrence
Moderate and severe BPSD are associated with an increased risk of mortality with HR 1.31 (95% CI, 1.08-1.60) and 1.74 (95% CI 1.44-2.12), respectively.
3

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of behavioral and psychological symptoms of dementia are prepared by our editorial team based on guidelines from the Canadian Coalition for Seniors' Mental Health (CCSMH 2024), the American Academy of Family Physicians (AAFP 2023), the European Academy of Neurology (EAN 2020), the Danish Health Authority (DHA 2019), the College of Family ...
Show more

Diagnostic investigations

Initial assessment: as per CCSMH 2024 guidelines, review the underlying etiology of dementia, the stage of dementia (mild, moderate, advanced), and the specific BPSD of concern, including the frequency, duration, severity, and any associated risks when assessing BPSD.
E
Show 3 more
Create free account

More topics in this section

  • Assessment tools (agitation)

  • Assessment tools (psychotic symptoms)

  • Assessment tools (depression)

  • Assessment tools (anxiety)

  • Assessment tools (sexual expressions)

Medical management

General principles: as per CCSMH 2024 guidelines, ensure interdisciplinary approaches to dementia care incorporating healthcare provider education on BPSD, structured approaches to assessment, individualized care plans, and personalized meaningful activities for the management of agitation in patients with dementia.
B
Show 3 more

More topics in this section

  • Management of cerebrovascular factors

  • Discontinuation of opioids

  • Antipsychotics (indications)

  • Antipsychotics (choice of agent and dosage)

  • Antipsychotics (tapering and discontinuation)

  • Antidepressants

  • Benzodiazepines

  • Anticonvulsants

  • Cannabinoids

  • Cholinesterase inhibitors

  • Other agents

Nonpharmacologic interventions

Physical activity
As per CCSMH 2024 guidelines:
Advise physical exercise for the management of agitation in patients with dementia.
B
Advise physical exercise for the management of depressive symptoms in patients with dementia in community and long-term care settings.
B

More topics in this section

  • Psychosocial interventions

  • Music therapy

  • Companion pets

  • Use of restraints

  • Alternative and complementary medicine

Therapeutic procedures

Electroconvulsive therapy: as per CCSMH 2024 guidelines, insufficient evidence to recommend for or against electroconvulsive therapy in the management of severe agitation in patients with dementia.
I

Preventative measures

Primary prevention
As per DHA 2019 guidelines:
Use person-centered care in the treatment of patients with dementia to prevent behavioral and psychological symptoms.
B
Consider offering the following to prevent behavioral and psychological symptoms in patients with dementia:
supervised fitness training
sleep hygiene in case of sleep disorders
reminiscence therapy
psychoeducation (at least 3 sessions) to relatives living together with patients with dementia
C

Follow-up and surveillance

Assessment of treatment response
As per CCSMH 2024 guidelines:
Assess the effectiveness of the treatment plan for BPSD routinely and evaluate the plan to consider adjusting, changing, or discontinuing strategies as appropriate.
E
Consider discontinuing pharmacological treatment for agitation in dementia if it is ineffective after 8 weeks of treatment, including at least 2 weeks at a therapeutic dose.
C