Managing the Behavioral and Psychological Symptoms of Dementia

Purpose of Review Alzheimer's disease and related dementias are the source of significant distress, impairment, and caregiver burden in aging populations. A prominent reason for this impact is the Behavioral and Psychological Symptoms of Dementia (BPSD). Common BPSD include disruptive behaviors, such as agitation, aggression, severe anxiety, delusions, depression, apathy, and sleep disturbances. Specific dementias, such as behavioral variant frontotemporal dementia and dementia with Lewy bodies, are associated with socioemotional disturbances and visual hallucinations, respectively. The aim of this review is to present current treatment options for the major BPSD. Recent Findings The management of the BPSD requires familiarity with non-pharmacological interventions and skill in the use of pharmacological agents in patients with dementias. This review outlines five important areas of non-pharmacological intervention. It then discusses the use of serotonergic medications, before considering antipsychotic drugs for disruptive behaviors and other BPSD. What is known about psychoactive drug use in cognitively normal populations does not necessarily apply to those with dementia, and the current treatment of patients with dementia emphasizes the need to consider their increased susceptibility to side effects from antipsychotic drugs. Summary Effective dementia care requires knowing both non-pharmacological and pharmacological interventions for the BPSD, which are present in nearly all patients with dementia at some time in their course. This review presents relatively easily applicable non-pharmacological techniques followed by discussions of the medication options for the major BPSD. In particular, clinicians need to understand current treatment strategies, particularly with regards to psychoactive medications, in this vulnerable population.

Automated summary

Alzheimer's disease and related dementias can cause significant distress, impairment, and caregiver burden in aging populations due to the Behavioral and Psychological Symptoms of Dementia (BPSD). Effective dementia care requires understanding both non-pharmacological and pharmacological interventions for BPSD. It is important for clinicians to be familiar with treatment options, especially related to psychoactive medications, in this vulnerable population.