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Behavioral and Psychological Symptoms of Dementia (BPSD
Behavioral and Psychological Symptoms of Dementia (BPSD
Papan Thaipisuttikul
Behavioral and Psychological Symptoms
of Dementia
Behavioral symptoms Psychological symptoms
• Usually identified on the
basis of observation : • Usually and mainly
assessed on the basis of
–Physical
y aggression
gg interviews with patients and
–Screaming family :
–Restlessness –Depressive
p mood
–Agitation
–Anxiety
–Wandering
–Hallucinations
a uc at o s
–Culturally
Culturally
inappropriate –Delusions
behaviors
–Sexual disinhibition
–Hoarding
–Cursing
C i
–Shadowing
Peak Frequency of Behavioral
S
Symptoms
t as AD Progresses
P
100
atients)
Agitation
80
Diurnal
Frequency ( % of Pa
Rhythm
60 Irritability
Depression
g
Wandering
Social
Mood Aggression
40 Withdrawal
Anxiety Change Socially
Paranoia Unacc. Hallucinations
20 Suicidal
Ideation Delusions
Accusatory
Sexually Inappropriate
0
-40
40 -30
30 -20
20 -10
10 0 10 20 30
Months Before / After Diagnosis
Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD), the
NSW Ministry of Health and the Royal Australian and New Zealand College of Psychiatrists May 2013
M
Management
t off BPSD
• Non-pharmacological management
first!
• Pharmacological management if:
* Harm to self
* Harm to others
* Unable to manage care
Clinical Practice Guidelines in
Thailand
ChEI role
l in
i BPSD managementt
• NICE : recommend donepezil especially
for agitation/aggression.
• SIGN : recommend all ChEI for BPSD in
AD and rivastigmine for BPSD related to
DLB, PDD.
• NSW : All ChEI for depression/dysphoria,
depression/dysphoria
anxiety and apathy. Rivastigmine for VH
and agitation in DLB
DLB.
• NSW : memantine for irritable, agitation,
aggression and psychosis in AD
AD.
Non-pharmacological management
f BPSD
for
• Maintain safety
• Modify environments
• Modify activities
• Modify communication
• Use distraction technique
ABC assessment for BPSD
Non-Pharmacological Rx for BPSD
Best Practice Guideline for Accommodating and Managing Behavioural and Psychological Symptoms of Dementia in
Residential Care.British Columbia.October 25, 2012