Management of behavioural and psychological symptoms of dementia and acquired brain injury

Abstract

Editor's note The practical management of the behavioural symptoms of dementia is one of the most pressing subjects in psychiatry. It is this, more than any other form of treatment, that decides whether a sufferer from dementia stays at home, in supported accommodation, or in hospital. It is therefore a very important subject, and this chapter illustrates what tends to happen when many hard-working and well-meaning clinicians decide, more or less independently, to investigate the value of different treatments. We get a large number of rating scales for assessment that overlap considerably, many published studies and many controlled trials that are difficult to combine in meta-analyses. As a consequence we derive a relatively poor evidence base, particularly in acquired brain injury, that makes it very difficult for the practitioner to choose how to proceed. But we must not be too unfair. The diagnostic system has not helped clinicians in the management of these symptoms and the notion of BPSD (Behavioural and Psychological Symptoms of Dementia) is a relatively recent one. It appears to be a good foundation on which to build. Introduction Non-cognitive symptoms of dementia have been labelled in different ways depending on the focus of the observation: agitation (Cohen-Mansfield et al ., 1989), behavioural disturbance (Baumgarten et al ., 1990), and dysfunctional behaviour (Malloy et al ., 1991), to name a few.