Understanding and managing the behavioral and psychological symptoms of dementia

Understanding and managing the behavioral and psychological symptoms of dementia

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CONFERENCE SPEAKER

In his well-attended APA Annual Meeting 2023 session, Clinicians’ Guide to the Management of Behavioral and Psychological Symptoms of Dementia in the Era of Canned Warnings, Rajesh R. Tampi, MD, MS, DFAPA, DFAAGP, discussed the emerging data on several important aspects of dementias, the most common neurodegenerative condition in humans. As Tampi shared, there are over 5 million people with dementia in the United States, and this number is projected to rise to over 11 million over the next 30 years. Despite the increasing prevalence, the diagnosis and management of these disorders are not standardized. How can clinicians address the behavioral and psychological symptoms of dementia (BPSD)?

Recognition is the first and most important step, Tampi said. Treatment must always be individualized, it is not good for everyone.

Common symptoms of BPSD include1:

-Anxiety (21% to 60%)

-Apathy (48% to 92%)

– Delusions (16% to 70%)

-Depression (30% to 50%)

-Disinhibition/impulsivity (30% to 35%)

-Hallucinations (4% to 76%)

-Inappropriate sexual behavior (7% to 25%)

– Mood lability (30% to 40%)

– Sleep disturbances (20% to 25%)

-Stereotypical behaviors (12% to 84%)

-Weight loss (15% to 20%)

If you suspect a patient has BPSD, you can follow the Tampis recommended assessment1 to confirm:

1. Obtain patient history. Medical, psychiatric, drugs, premorbid personality, cognition, function, etc.

2. Complete a physical exam to rule out underlying medical or neurological disorders.

3. Order investigations, such as blood tests, urine tests, vitamin B12 and folate levels, neuroimaging, and more.

4. Comprehensive standardized rating scales and/or neuropsychological tests.

5. If there are underlying medical or neurological disorders, treat them.

6. If any drug has adverse effects, remove the offending drug.

7. Confirm that the patient has BPSD.

Tampi also provided participants with evidence-based non-pharmacological interventions. According to systematic review data, psychoeducation and staff education were effective in reducing BPSD symptoms.2 Additionally, person-centred care, communication skills training, and adapted dementia care mapping reduced turmoil in nursing homes immediately and for up to 6 months.3 Activities and music therapy also had some effect in reducing general agitation.3

As for drug treatments, Tampi shared with participants that if monotherapy fails, doctors should use judicious combinations of drugs, such as antidepressants with antipsychotics or mood stabilizers. He also said that clinicians should frequently evaluate the efficacy and adverse effects of all medications, especially controlling for modifiable cerebrovascular and cardiovascular risk factors.4

It’s how we prescribe that matters, Tampi said.

References

1. Tampi RR, Bhattacharya G, Marpuri P. Management of behavioral and psychological symptoms of dementia (BPSD) in the era of canned warnings. Curr Psychiatry Rep. 2022;24(9):431-440.

2. Livingston G, Johnston K, Katona C, et al. Systematic review of psychological approaches to managing the neuropsychiatric symptoms of dementia. I am J psychiatry. 2005;162(11):1996-2021.

3. Livingston G, Kelly L, Lewis-Holmes E, et al. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological, and behavioral interventions for the management of agitation in older adults with dementia. Health technology assessment. 2014;18(39):1-226, v-vi.

4. Tampi RR, Williamson D, Muralee S, et al. Behavioral and psychological symptoms of dementia: part of treatment. Clinical geriatrics. June 2011. Accessed May 30, 2023. https://medicine.yale.edu/intmed/geriatrics/fellowships/medicine/bpsd_part%202_clinical%20geriatrics_101891_284_38753_v1.pdf

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