Dementia: Behavioural and Psychological Sx

Question 1

What are behavioural and and psycholgical sx of dementia? [+]

Answer 1

• Repetitive behaviour and speech
• Mood disturbance (eg depression, lability, anxiety)
• Apathy
• Social inappropriateness
• Agitation
• Aggression
• Shouting
• Wandering
• Hoarding
• Psychosis - delusions and/or hallucinations
• Sleep disturbance
• PTSD - reliving early life traumas

Question 2

What is a mneumonic for remembering BPS of dementia? [+]

Answer 2

PIECES:
* Physical problem or discomfort
* Intellectual/cognitive change
* Emotional
* Capacities - are they being supported to what they previously enjoyed?
* Environment - are there clear signs about where they are / noise / care staff regular?
* Social/cultural factors - are being offered appropriate food / chance to pray?

Question 3

What are common physical things need to assess in dementia patients as they might not be able to communicate these issues? [+]

Answer 3

Acute medical illness:
- cough
- SOB
- chest pain
- urinary retention
- constipation

Disorientation due to missing glasses / hearing aid

Medication side effects
- Anticholinergics - impair memory and behaviour
- benzos impact cognition and may risk falls

May forget how to swallow

Recent SDH ?

Question 4

Describe the intellectual and cognitive changes that may occur in dementia [+]

Answer 4

• Amnesia, aphasia, agnosia, apraxia, anosognosia, altered perception, apathy

Question 5

Which basic measures may help with BPS? [5]

Answer 5

Management 1: Basic good practice
* Appropriate environment - space, light, privacy
* Reorientation - time (clock), reminder sheet, routines
* Reassurance - familiar environment and people
* Optimal level of stimulation - activities, calm
* Physical activity to absorb restless energy and improve mood
* Excellent communication - clear, simple sentences, hearing aids, glasses, hearing loops, allow time for response, check understanding

Question 6

Describe what an ABC chart is for beahviours that challenge? [3]

Answer 6

Contains information about:
A - Antecedent - what was happening just before event?

B - Target behaviour:
- E.g. the exact behaviour that caused concern (e.g. slapping away the arm of the nurse)

C - Consequence - how was the situation resolved?

Question 7

Describe the role of medications in BPSDs [4]

Answer 7

If underlying depression - sertraline is used

Agitation and irritability - trazadone

BDZ - reduce agitation but risk of falls, sedation and worsening congition

Antipsychotics
- 2nd generation have been linked with 2-3x increased risk of CV adverse events and death. BUT: re-exam of data shows that actual psychotic sx respond well
- 1st generation: have linked risk of EPSE and arrythmias
- Risperidone is the only antipsychotic liscenced in dementia

Question 8

Describe the NICE guidelines for prescrining anti-psychotics for BPSD? [3]

Answer 8

Risperidone is the only liscenced drug

Can prescribe only if:
- Risk of harming self or others
- Experiencing agitation, hallucinations or delusions causing severe distress

Reassess every 6 weeks

Question 9

Which group do you need to beware with antipsychtoics in BPSD [2]

Answer 9

If LBD or PD w dementia as may worsen motor sx or can make severe antipsychotic sensitivity reactions

Question 10

What are deprivations of liberty safeguards (DoLS)? [3]

Answer 10

Deprivation of Liberty Safeguards (DOLS):
* Under continuous supervision and control
* Not free to leave
* Lacks capacity to con to this