From the Guidelines
The initial treatment approach for mild dementia with Behavioral and Psychological Symptoms of Dementia (BPSD) should prioritize non-pharmacological interventions over medications, focusing on establishing consistent daily routines, creating a calm environment, and providing appropriate stimulation and support. This approach is supported by the most recent and highest quality study, which emphasizes the importance of non-pharmacological strategies in managing BPSD 1. The study recommends considering non-pharmacological strategies as first-line management for individuals with vascular cognitive impairment (VCI) who are displaying behavior changes, and suggests that structured and tailored activities, as well as supporting the caregiver, may be beneficial.
Key non-pharmacological interventions include:
- Establishing consistent daily routines to provide a sense of structure and familiarity
- Creating a calm environment by reducing noise and clutter
- Providing appropriate stimulation through activities like music therapy or reminiscence therapy
- Ensuring caregivers receive proper education and support to manage BPSD
- Addressing physical needs, such as adequate nutrition, hydration, pain management, and treating underlying medical conditions
- Implementing communication strategies, such as speaking clearly and maintaining eye contact, to reduce agitation and confusion
- Making environmental modifications, like adequate lighting and removing hazards, to support the person with dementia
Medications should only be considered if these non-pharmacological approaches prove insufficient, and then only at the lowest effective dose with regular reassessment 1. This approach prioritizes safety and quality of life while minimizing the significant risks associated with psychotropic medications in elderly patients with dementia, including increased mortality, falls, and cognitive decline.
From the Research
Initial Treatment Approach for Mild Dementia with BPSD
The initial treatment approach for mild dementia with Behavioral and Psychological Symptoms of Dementia (BPSD) involves a multi-step process.
- The first step is to address any contributing medical problems 2.
- Non-pharmacological interventions should be tried prior to pharmacological interventions 2, 3, 4, 5.
- These non-pharmacological interventions may include personalized approaches such as physical exercise, music therapy, reminiscence therapy, and pet therapy 3.
- Collaborative care from care providers and family members is also an important factor in the management of BPSD 3.
Pharmacological Interventions
Pharmacological interventions, such as antidepressants and antipsychotics, may be considered if non-pharmacological interventions are not effective or if the symptoms are severe 2, 4, 5.
- Antipsychotics should be prescribed only when behaviors pose a significant safety risk or if the person with dementia is very distressed 2.
- Atypical antipsychotics, such as risperidone, olanzapine, and quetiapine, are commonly used to treat BPSD due to their effectiveness and lower risk of side effects compared to conventional antipsychotics 5.
Individualized Approach
The management of BPSD is highly individualized, and the treatment approach should be tailored to each person's specific needs and symptoms 2, 6.