Antipsychotics in dementia: Best Practice Guide

Introduction, Rationale and Key Points   Behavioural and Psychological Symptoms of Dementia (BPSD)   Assessment of patients with BPSD   Non-pharmacological treatment of BPSD   Pharmacological treatment of BPSD   Adverse effects of antipsychotics   Dementia with Lewy Bodies (DLB)   Other medicines for BPSD   Treatment of comorbid conditions in patients with dementia   References   Appendix

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Behavioural and Psychological Symptoms of Dementia

Behavioural and psychological symptoms of dementia are usually transient and often respond to simple changes in the environment or removal of an aggravating factor.

What are BPSD?

Behavioural and psychological symptoms of dementia (BPSD) refer to the often distressing non-cognitive symptoms of dementia and include agitation and aggressive behaviour. BPSD have been defined as symptoms of disturbed perception, thought content, mood or behaviour, frequently occurring in patients with dementia.³ Other common terms in use for these symptoms include neuropsychiatric symptoms of dementia, behaviour that challenges or non-cognitive symptoms of dementia.⁴

The spectrum of BPSD includes: (Adapted from⁵)

• Aggression
• Agitation or restlessness; screaming
• Anxiety
• Depression
• Psychosis, delusions, hallucinations
• Repetitive vocalisation, cursing and swearing
• Sleep disturbance
• Shadowing (following the carer closely)
• Sundowning (behaviour worsens after 5pm)
• Wandering
• Non-specific behaviour disturbance e.g. hoarding

How common are BPSD ?

BPSD of varying degrees of severity are present in more than 80% of patients with dementia.⁶ An estimate of the prevalence of BPSD in the community comes from the USA Cache County Study. This study reported that 61% of patients had one or more BPSD and in over half of these cases the symptoms were rated as severe. The most common individual symptoms were apathy 27%, depression 20%, irritability 20%, aggression/agitation 24% and delusions 19%.⁷

These symptoms may also be responsible for more institutionalisation, caregiver stress and use of health care resources than cognitive symptoms. As there is no cure for dementia, the appropriate treatment of BPSD can have a significant impact on the quality of life of both patient and caregiver.⁸

It is poorly recognised that BPSD are usually transient and often respond to simple changes in the environment or removal of an aggravating factor.

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