Behavioral and Psychological Symptoms of Dementia

Abstract

Laurel Halloran, PhD, APRN Dementias are one of the most feared disorders of later life and the most devastating in their toll on patient suffering and dysfunction. They are associated not only with deficits in cognition and self-care but also with psychiatric and behavioral symptoms. Most patients with dementia will develop changes in behavior and personality as the disease progresses, which disrupt family, social, and institutional networks. Alois Alzheimer noted that behavioral and psychological symptoms of dementia (BPSD) are prominent manifestations of the illness, including paranoia, delusions, hallucinations, agitation, wandering, and disinhibition behaviors. The evaluation of BPSD requires special considerations. A careful medication review is the first step. New medications, especially anticholinergic, psychoactive, and cardiovascular medications, should be evaluated. Two instruments are useful to assess the range and severity of BPSD. The CoheneMansfield Agitation Inventory examines 29 types of agitated behavior (pacing, verbal or physical aggression, repetitious mannerisms, screaming, and general restlessness) and takes approximately 10 to 15 minutes to administer. The Neuropsychiatric Inventory examines 12 neuropsychiatric symptoms (delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, nighttime behavior disturbances, and appetite and eating abnormalities) common in dementia. This brief semistructured interview is administered by a clinician to a caregiver for rating the severity and frequency of the behaviors. Two characteristic precursors to wandering are restlessness and disorientation. Patients should be evaluated for an underlying precipitating