From the Guidelines
Treatment for dementia with behavioral symptoms should prioritize non-pharmacological interventions, with pharmacological treatments used as adjuncts or when necessary.
Overview of Treatment Options
- Non-pharmacological treatments (NPTs) are generally well accepted, have minimal adverse side effects, and can be combined with other NPTs and pharmacological treatments without major concerns around interference 1.
- NPTs cover a diverse range of intervention categories, including cognitive training, physical exercise, dietary treatments, art-oriented therapy, and reminiscence therapy.
- Pharmacological treatments, such as cholinesterase inhibitors and memantine, can result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia 1.
Pharmacological Treatment
- The choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication 1.
- Cholinesterase inhibitors and memantine are FDA-approved pharmacologic therapies for dementia, with evidence showing small effect sizes in the domains of cognition and global assessment 1.
Non-Pharmacological Treatment
- NPTs have the potential to have a meaningful impact on cognition, well-being, and quality of life throughout the course of age-related neurodegenerative diseases 1.
- A conceptual framework for organizing and classifying research in NPT can help improve methodological and reporting standards in this area of research 1.
Clinical Guidelines and Management
- Clinical guidelines for dementia management focus on timely detection, improvement of service quality, person-centered and integrated dementia services, dementia awareness and friendliness, and scientific research of dementia 1.
- The overall goals of dementia treatments include postponing the process of cognitive decline and reducing pain caused by cognitive decline, behavioral and psychological symptoms of dementia (BPSD) 1.
From the Research
Treatment Options for Dementia with Behavioral Symptoms
- Nonpharmacologic treatments are recommended as the first line of treatment for behavioral symptoms in dementia, as they can significantly improve quality of life and patient-caregiver satisfaction 2.
- Examples of nonpharmacologic treatments include:
- Provision of caregiver education and support
- Training in problem solving
- Targeted therapy directed at the underlying causes for specific behaviors
- Pharmacologic treatments, such as antipsychotics and antidepressants, may be used in certain situations, but their use is associated with significant risks and limited benefits 3, 4, 5, 6.
Assessment and Management of Behavioral Symptoms
- Comprehensive assessment of patients with behavioral and psychological symptoms of dementia (BPSD) is essential to identify underlying causes and develop an effective treatment plan 3, 5, 6.
- Nonpharmacologic interventions should be tried prior to pharmacologic interventions, and antipsychotics should be prescribed only when behaviors pose a significant safety risk or if the person with dementia is very distressed 3.
- The management of BPSD is highly individualized, and treatment plans should be tailored to the specific needs of each patient 3, 4.
Effectiveness of Different Treatments
- Memory therapy, ergotherapy, music therapy, and physical exercise have been shown to be effective in reducing behavioral symptoms in dementia 4.
- Antidementia drugs, such as galantamine, donepezil, rivastigmine, and memantine, may also be effective in reducing behavioral symptoms 4.
- Risperidone has been shown to be effective in reducing agitation and aggressiveness in patients with dementia 4.
- Citalopram may be effective in treating depression in patients with dementia 4.