BPSD

Question 1

What is BPSD?

Answer 1

Signs and symptoms of disturbed perception, thought content, mood or behaviour that frequently occurs in dementia

Question 2

What are the four domains of BPSD?

Answer 2

Somatic
Behavioural
Affective
Psychotic

Question 3

What is the most common BPSD?

Answer 3

Apathy

Question 4

Which anti-depressants are used in BPSD? Why?

Answer 4

Mirtazapine
- Helps with agitation
- SE profile of weight gain and sedation are beneficial
- Can’t get serotonergic syndrome with it
Citalopram

Question 5

Which anti-psychotics are used in BPSD? Why?

Answer 5

Typicals - Haloperidol
Atypical - Risperidone, Olanzapine, Quetiapine (only risperidone is licensed)

Anti-agitation/psychotic effect

SE: EPS, NMS, metabolic, sedation

Question 6

What is the risk of using risperidone in BPSD?

Answer 6

Increases the risk of stroke x4-5 when used for agitation (not psychosis)
Increases the risk of pneumonia

Question 7

Which classes of drugs are used in BPSD?

Answer 7

Anti-depressants
Anti-psychotics
Cognitive enhancers
Mood stabilisers

Question 8

Which cognitive enhancers do you use? What can be their benefit?

Answer 8

AchEi - Donepezil, rivastigmine, galantine
NMDA - Memantine
- Can help with the 3 A’s: apathy, aggression, and agitation

Question 9

Which mood stabilisers are used in BPSD?

Answer 9

Carbemazepine

Sodium valproate

Question 10

What are some environmental interventions?

Answer 10

• Support function in a prosthetic manner
  ○ Eg optimise their sensory impairment
• Positive regard
• Minimise/avoid triggers
  ○ Using touch to reassure
  ○ Using calm tone
  ○ Avoid correction or “you’re wrong attitude”
  ○ Use distraction rather than confrontation
  - Validate or confront their environment depending on whether it’s helpful or harmful
• Caregiver education