Integrating Non-pharmacological and Pharmacological Interventions in the Treatment of Behavioral and Psychological Symptoms of Dementia

Abstract

Non-pharmacological interventions (NI) are accepted as the first line treatment to reduce the severity and frequency of behavioral symptoms of dementia (BPSD). However, there is a marked paucity of evidenced-based NI for BPSD, leading psychiatric providers to rely too heavily on the second-line treatment for BPSD; pharmacological interventions (PI). This clinically focused presentation will demonstrate a comprehensive approach for psychiatric providers to educate family and caregivers on NI aimed to reduce the severity and frequency of BPSD, as well as integrate this teaching material with PI psycho-education. Types of NI for BPSD include sensory stimulation interventions, cognitive/emotion-oriented interventions, behavior management techniques as well as exercise and pet therapy, with music therapy and behavioral management having the most evidence for reducing BPSD. There are multiple barriers to determining evidenced based NI, which has led to geriatric psychiatry expert consensus treatment guidelines for BPSD, namely the DICE approach. The evidenced based dementia care training program STAR (Staff Training in Assisted living Residences) has demonstrated significant reduction in BPSD in dementia patients residing in the assisted living setting. Key components of this behavior management approach can be applied by psychiatric providers to family and caregiver education in the clinic and long-term care setting. Published qualitative data on barriers to implementation of dementia psycho-education have been identified, and practical strategies can counter these, including teaching providers to quickly assess family/caregiver education needs, modeling communication skills, implementing pleasant event schedules for patients to reduce BPSD, and learning how to code/bill for time spent not involving face to face time with patients. These strategies can be integrated with already published treatment algorithms for PI for BPSD, though it requires psychiatric providers to effectively educate caregivers and family members on realistic expectations and safety risks associated with PI for BPSD. Psychiatric providers can then utilize this integrated approach in their consultative role with primary care and long-term care providers. Further investigation into the effectiveness of this integrated BPSD approach is needed as well as a concerted effort to systematize the delivery of psycho-education into dementia care.