The role of pain treatment in managing the behavioural and psychological symptoms of dementia (BPSD)

Abstract

ore than 90% of people with dementia experience at least one behavioural and psychological symptom of dementia (BPSD) over the course of the condition (Steinberg et al, 2008). BPSD include aggression and non-aggressive agitation, which occur in approxi-mately 20% of people with Alzheimer’s disease (AD) who are in contact with clinical services or living in the community, and 40–60% of people with dementia who are in care facilities (Margallo-Lana et al, 2001). Common manifestations of agi-tation include restlessness/pacing, verbal insults, shouting, and physical aggression, and most often occur during personal care. Delusions and halluci-nations are also present in 25% of people with dementia in clinical settings (Steinberg et al, 2008), and depression occurs in 20% of people with AD (Ballard et al, 2009a). The depression symptoms are similar to those seen in people without demen-tia, but are also often associated with an apparent deterioration in function and cognition. In most of these individuals BPSD have a clin-ically significant impact. They are often distress-ing for the patients who experience them, lead to stress and depression in carers, are associated with a reduced quality of life, and are often the trigger for institutional care (Ballard et al, 2009a; 2009b).