Managing the behavioural and psychological symptoms of dementia

Course Content

Dementia is a medical condition characterized by a decline in memory, language, problem-solving and other thinking skills that affect a person’s ability to perform everyday activities.

World Health Organization (WHO, 2019) reported that around 50 million people have dementia worldwide, and there are nearly 10 million new cases every year. The most common type of dementia is Alzheimer’s dementia (AD) accounting for 60%–80% of all cases. The number of people with AD continues to increase rapidly due to the rise in the aging population aged 65 and older.

Behavioural and psychological symptoms of dementia (BPSD) encompass potentially disruptive behaviours associated with significant functional and clinical impairment, such as aberrant motor behaviours, apathy, sleep disturbance, agitation, anxiety, depression, irritability, psychosis, delusions, hallucinations, and appetite changes. BPSD has the potential to negatively impact the quality of life, illness, treatments, deterioration of family and professional relationships, and caregiver burdens. Therefore, the treatment of BPSD must be individualised according to four factors: adequate pain management, managing somatic disease(s), optimising non-pharmacological plan and interventions, and pharmacotherapy. Current evidence suggests that non-pharmacologic strategies, such as family caregiver interventions, show greater effect than most drug treatments.

However, drugs still have their place, especially for the management of acute situations where the safety of the person with dementia or family caregiver may be at risk. An evidence-based standardized approach is needed that can detect and manage symptoms, carefully consider possible causes, and then integrate pharmacological and non-pharmacological treatments. Nonpharmacological interventions have many components with complicated (multi-level and multi-site) and complex (emergent outcomes) aspects, which is challenging for evaluation as the number of variables that can be identified and investigated is limited while the path to success is variable and cannot be formulated in advance.

This article argues for giving equal weight to both the collection of meaningful information and the development of ‘informed actions’, because it is the actions that lead to change.

Learning Outcomes

In this session, you will:

• Learn about the need to utilize a non-pharmacological approach when managing dementia
• Discuss the potential reasons pharmaceuticals can disrupt the management of dementia
• Investigate how the dosing of pharmaceutics can be monitored to achieve better outcomes
• Read about the management of antipsychotics in dementia