Chapter 16 Behavioral Syndromes and Their Treatment

Abstract

The chapter discusses the behavioral syndromes and their treatment. Neuropsychiatric symptoms occur commonly in dementia. The most prevalent symptoms are apathy, depression, agitation, irritability, and anxiety. Recognition of the importance of behavioral symptoms is reflected in the diagnostic criteria for frontotemporal lobar degeneration (FTLD) and dementia with Lewy bodies (DLB), which include neuropsychiatric manifestations. The commonly employed diagnostic criteria for Alzheimer's disease (AD) and vascular dementia (VaD) include neuropsychiatric alterations as significant additional supportive symptoms. This chapter focuses on dementias, as well as on mild cognitive impairment (MCI), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and Parkinson's disease with dementia (PDD). Cholinergic deficits are thought to play an important role in the development of neuropsychiatric symptoms in AD. FTLD consists of three distinct syndromes: frontotemporal dementia (FTD), progressive nonfluent aphasia, and semantic dementia. PSP presents with vertical gaze palsy, axial Parkinsonism with significant postural instability, dysarthria, and a subcortical dementia with executive dysfunction. It is essential to treat behavioral disturbances in addition to cognitive and functional impairment in dementia because of the significant burden they inflict on patients and their caregivers. Management should consist of nonpharmacologic and pharmacologic interventions, as well as a strong alliance with the caregiver and support for the caregiver who often facilitates the entire process.