From the Guidelines
Behavioral and Psychological Symptoms of Dementia (BPSD) should be managed with a combination of non-pharmacological approaches first, followed by medications only when necessary, as stated in the most recent and highest quality study 1.
Key Considerations
- Initial management should focus on identifying and addressing underlying causes such as pain, infection, or environmental factors.
- Non-pharmacological interventions include maintaining consistent routines, providing meaningful activities, music therapy, reminiscence therapy, and caregiver education.
- When medications are required, start with low doses of atypical antipsychotics like risperidone (0.25-0.5mg daily), quetiapine (25-50mg daily), or olanzapine (2.5-5mg daily) for severe agitation, aggression, or psychosis, as recommended by 1.
Medication Management
- These medications should be used at the lowest effective dose for the shortest duration possible (generally reassess after 6-12 weeks) due to increased mortality risk.
- For anxiety or depression, consider SSRIs like sertraline (25-100mg daily) or citalopram (10-20mg daily), as suggested by 1.
- Acetylcholinesterase inhibitors such as donepezil (5-10mg daily) or memantine (5-20mg daily) may help with both cognitive symptoms and some behavioral issues.
Important Considerations
- Avoid benzodiazepines when possible due to increased fall risk and potential worsening of cognition.
- Regular reassessment is crucial, aiming to reduce or discontinue psychotropic medications when symptoms improve.
- BPSD often fluctuates over the course of dementia, requiring ongoing adjustments to the management approach based on the individual's changing needs and response to interventions, as highlighted in 1 and 1.
From the Research
Definition and Prevalence of BPSD
- Behavioral and psychological symptoms of dementia (BPSD) are nearly universal in dementia, occurring in more than 40 million people worldwide 2.
- BPSD includes a group of symptoms of disturbed perceptive thought content, mood, or behavior, such as agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and wandering 3.
Symptoms of BPSD
- Cognitive manifestations are usually the primary abnormalities in dementia, but noncognitive symptoms, including BPSD, are distressing for both patients and their caregivers 4.
- BPSD can include symptoms such as agitation, aggression, psychosis, and mood disturbances, which can be disruptive and life-threatening for patients and surrounding people 4, 5.
Management of BPSD
- Non-pharmacological interventions, such as caregiver training, environmental adaptations, person-centered care, and tailored activities, are recommended as first-line approaches for managing BPSD 2, 5, 3.
- Pharmacological interventions, such as antidepressants, antipsychotics, and analgesia, may be used if non-pharmacological interventions are not effective, but should be targeted to specific symptoms and used with caution due to potential side effects 2, 4, 5, 6.
- Antipsychotics, such as risperidone, may be prioritized for psychosis, while citalopram and other selective serotonin reuptake inhibitors (SSRIs) may be effective for agitation with lower risk of adverse effects compared to antipsychotics 2, 6.