Managing Behavioral and Psychological Symptoms of Dementia In The Era Of Boxed Warnings

Abstract

Dementias are the most common neurodegenerative conditions in human beings. As we age, the incidence and prevalence of dementias increase. Currently in the United States, there are over 6 million individuals with dementias. This number is projected to rise to over 13 million over the next thirty years. Despite emerging data on various important aspects of dementia, the diagnosis and management of these disorders is not standardized. The data on the management dementias is still limited with none of the pharmacotherapeutic agents available in the market showing any longer-term benefits. Behavioral and Psychological Symptoms of Dementia (BPSD) refers to a group of non-cognitive symptoms and behaviors that occur commonly in patients with dementia. They result from a complex interplay between various biological, psychological, and social factors involved in the disease process. BPSD is associated with increased caregiver burden, institutionalization, a more rapid decline in cognition and function and overall poorer quality of life. It also adds to the direct and indirect costs of caring for patients with dementia. Available data indicate efficacy for some non-pharmacological and pharmacological treatment modalities for BPSD. However, recently the use of psychotropic medications for the treatment of BPSD has generated controversy due to increased recognition of their serious adverse effects. We will also provide an evidence-based guideline to assess and manage these individuals.