Neuropsychiatric Symptoms of Dementia

Question 1

Approach to behavior management

Answer 1

Define target symptoms
Establish or revisit medical diagnoses
Establish or revisit neuropsychiatric diagnoses
Assess and reverse aggravating factors
Adapt to specific cognitive deficits
Identify relevant psychosocial facotrs
Educate caregivers
Employ behavior management principles
Use psychotropics for specific psychiatric syndromes

Question 2

BBW for ALL Antipsychotics

Answer 2

Elderly patients with dementia-related psychosis have a 1.6-1.7 increased risk of death

Question 3

Non-pharm management of depression

Answer 3

Scheduled toileting, prompted toileting
Offer graded assistance
Redirect conversations
Maintain a calm demeanor
Use services of caregiver support groups

Question 4

Schizoprehenia

Answer 4

Positive symptoms: hallucinations, delusions, and thought disorder
Negative symptoms: social dilapidation and apathy

Question 5

Preferred APS

Answer 5

Aripiprazole
Olanzapine
Quetiapine
Risperidone

Question 6

Brexpiprazole

Answer 6

Treatment of agitation associated with dementia due to Alzheimer’s disease
BBW still applies

Question 7

Depressive symptoms

Answer 7

Sadness, loss of interest in usual activities, anxiety, and irritability

Question 8

Mirtazepine

Answer 8

Useful for depression with insomnia and weight loss
Causes sedation, hypotension, may increase appetite

Question 9

Trazodone

Answer 9

Useful when sedation is desirable

Question 10

Treatment of apathy

Answer 10

Methylphenidate, dextroamphetamine, modafinil

Question 11

Mood stabilizers for dementia and mania

Answer 11

Carbamazepine
Lamotrigine
Lithium
Divalproex sodium

Question 12

Sundowning

Answer 12

Forgetful, confused, delirious, agitated, anxious, restless
Treatment with trazodone, melatonin, antipsychotics, atypicals, quetiapine

Question 13

Treatment of insomnia

Answer 13

Trazodone, melatonin, benzos (short term use only)