BPSD

Question 1

Define BPSD

Answer 1

Symptoms of disturbed perception, thought content, mood or behaviour that frequently occur in patients with dementia (neuropsychiatric, but not cognitive i.e. not related memory)

Question 2

Natural Hx of BPSD

Answer 2

Sx are often transient. They tend to emerge, worsen, plateau, then vanish

Question 3

When does BPSD occur in dementia?

Answer 3

• Changes in behaviour and personality are commonly associated with later stages of dementia (mood changes are earlier than aggression and agitation)
• NB: in fronto-temporal dementias, disinhibited behaviours can occur before significant cognitive decline

Question 4

DDx of BPSD

Answer 4

Delirium
Secondary causes of behavioural disturbance
	• Inter-current physical illness
	• Depression
	• Pain
	• Faecal impaction
	• Infection (UTI especially)
	• Urinary retention
	• Fatigue
	• Adverse effects of medication

Environmental factors causes of disturbed behaviour
• Loud noises
• Boredom
- Unfamiliar surroundings

Question 5

Hx findings of BPSD

Answer 5

1. Agitation: anxiety, irritability, verbal and physical aggression, motor restlessness, pacing, wandering, night time disturbances/nocturnal restlessness
2. Psychosis: hallucinations, delusions, misidentifications
3. Mood disorders: depression, anxiety or occasionally mania
4. Sexual disinhibition
5. Eating problems
6. Abnormal or inappropriate vocalisation: shouting, screaming, demanding attention
   Hallucinations are uncommon but can occur in late dementia (LBD visual hallucinations are common early)

Question 6

Non drug management of BPSD

Answer 6

Non-pharmacological *first
1. Remove noxious stimuli where possible
2. Reduce or relieve pain and other cause of distress
3. Assess relatives/staff to understand behaviours in context
4. Remove unnecessary/ineffective medication
5. Remember carer distress is a legitimate clinical target
Identify target Sx for treatment

Question 7

Drug management of BPSD

Answer 7

• The best evidence for efficacy exists for the novel anti-psychotics risperidone (only approved drug for BPSD under PBS) and haloperidol can also be prescribed. Others olanzapine and quetiapine
  
  • This should be used PRN initially, however, if symptoms are frequent then consider long term
  • Evidence for the efficacy of drugs is limited and risk of adverse effects including death with antipsychotics is significant
  • Do not use in fronto-temporal dementia - accelerates