Behavioral and Psychological Symptoms in Dementia

Key findings used in wiki

• Non-pharmacological interventions for behavioral and psychological symptoms of dementia (BPSD) may be sufficient on their own for mild BPSD, and should continue alongside any medication that is later added.
• A meta-analysis of 10 randomized controlled trials in patients with moderate to severe dementia found no significant overall benefit from non-pharmacological interventions, with two exceptions: music therapy reduced overall BPSD, and massage therapy reduced depression.
• That meta-analysis excluded caregiver-training interventions, which were separately shown to reduce a range of BPSD symptoms and improve caregiver well-being; a structured protocol called 'Bathing without a Battle,' taught to family caregivers, reduced agitation, bathing time, and antipsychotic use in a randomized multi-site crossover study of patients whose BPSD occurred mainly during personal care.
• Severe agitation or aggressive behavior that endangers the patient or others usually requires immediate initiation of antipsychotic therapy and consideration of referral to a geropsychiatry unit or hospital, rather than caregiving technique alone; discontinuation of long-term antipsychotics is also less likely to succeed once a patient has had severe symptoms.
• The FDA has issued a black box warning for antipsychotic medications in elderly patients with dementia because of an increased risk of death (about 3.5% vs. 2.3% in trials, mainly from cerebrovascular events and infections), so antipsychotics are recommended only after non-pharmacological approaches and other medications (such as SSRIs) have been ineffective, or when the patient is a danger to themselves or others.