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Behavioral and psychological symptoms of dementia

Definition
BPSD is a heterogeneous range of psychological reactions, psychiatric symptoms, and behaviors occurring in people with dementia of any etiology.
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Pathophysiology
BPSD are caused due to a complex interplay of psychological, social, and biological factors including neurochemical, neuropathological and genetic factors.
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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.
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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.
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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 American Academy of Family Physicians (AAFP 2023), the European Academy of Neurology (EAN 2020), the Danish Health Authority (DHA 2019), the College of Family Physicians of Canada (CFPC 2018), the American Psychiatric Association (APA 2016; 2007), the American Geriatrics Society (AGS 2015), and the Canadian Geriatrics Society (CGS 2012).
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Guidelines

1.Diagnostic investigations

Initial assessment
Assess the type, frequency, severity, pattern, and timing of symptoms in patients with dementia.
B
Assess for pain and other potentially modifiable contributors to symptoms as well as for factors, such as the subtype of dementia, likely to influence treatment choices.
B
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2.Medical management

General principles: as per DHA 2019 guidelines, consider offering pharmacotherapy for dementia in patients with dementia Alzheimer's disease, dementia with Lewy bodies, orParkinson's disease dementia) and recent-onset behavioral and psychological symptoms.
C

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3.Nonpharmacologic interventions

Use of restraints
Use physical restraints in patients with behavioral symptoms of dementia only if patients pose an imminent risk of physical harm to themselves or others.
A
Avoid using physical restraints if patients do not pose an imminent risk of physical harm to themselves or others.
D

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4.Preventative measures

Primary prevention
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

5.Follow-up and surveillance

Assessment of treatment response: assess treatment response with a quantitative measure in patients with dementia with agitation or psychosis.
B