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Behavioural and Psychological Symptoms of Dementia - Coggle Diagram
Behavioural and Psychological Symptoms of Dementia
Behavioural Cluster Approach
Apathy: Withdrawan, lack of motivation, indifference
Aggression: Verbal aggression, physical aggression, threatening gesture
Agitation: Restless, repetitive, pacing, wandering, exit seeking, hoarding, resistive to care
Mood: Sad, irritable, anxious, labile
Disinhibition: Socially innapropriate behaviour, sexually inappropriate behaviour
Psychosis: Suspicious, hallucination, delusion
Night-time behavior: Insomnia (early, middle, terminal)
Assessment
Obtain History: Medical, psychiatric, meds, cognition, function, personality
Physical Exam: Rule out acute medical conditions, neurological disorders
Investigations: Blood work, urinalysis, neuroimaging
Standard Rating Scales: CMAI, NPI
CMAI
Assesses verba agitation, non-agressive physical agitation, aggressive physical agitation
Neuropsychiatric Invesntory (NPI)
Assesses psychotic symptoms, mood.apathy, Hyperactivity
Non-Pharmacologic Management Strategies
Patients
Reminiscence, validation, walking/exercise, aromatherapy, snoezelen, acupuncture, lgiht therapy
Caregivers
Strongest evidence among non-pharm (Psychoeducation, training in stress reduction, enhanced communication, reudced physcial enviornment complexity)
Provide a personal approach, a daily routine, and use simple communication skills
Environmental
Eliminate misleading stimuli, Reduce enviornmental stress, adjust stimulation, Enhance function
Use of Restraints
If patient is at acute risk of harming self, others
Patient must have medical investigations
Negative consequences
Functional decline, injury, poor ciruclaiton, incontinence
Pharmacologic Management
Indications
Dangerous behaviour that does not respond to nn-pharm plans, removal of offending agents, and not responded to treatments
Psychotropic Meds
Underlying edical causes, screen for psychiatric disorders, monitor, identify goal of therapy, obtain consent, start medications at lowest dose
Symptoms that do not respond
Wandering, exit seeking, inappropriate voiding, undressing, perseverative acitivties, vocalization, hoarding
Symptoms that are responsive
Physical aggression, verbal aggression, anxious,sadness, sleep disturbance, delusion, innapriproate sexual behaviour
Medication Types
Antidepressiatnts for mild, Antipsychotics for moderate/severe
Cholinesterase Inhibitors: Delay emergence of apathy
Trazadone: Anxiety/Sundowning effects
Carbamazepine
Benzodiazipines
Melatonin
ECT
BPSD
Definition
Symptoms of dementia, behavioural disturbances in dementia, and neuropsychiatric symptoms
Heterogenous group of non-cgntiive symptoms in dementia
Can appear at all stages and can precede diagnosis of dementia by 2+ years
Common in Mild NCD
Depression, Apathy irritability, agitation, anxiety, sleep disturbance
Persistence
May last 6+ months and more likely to persist as apathy, agitation, anxiety, depression
Impact
Increase patient/caregiver distress, poor outcomes, increased instituitonalization, more rapid decline
Differences in Dementia
Vascular: More depression, apathy, sleep disturbance
FTD: More delusion, disinhibtiion, abnormla motor, wandering, apathy
Lewy body: More delusion and hallucination
Associated Facotrs
Patient Factors
Underlying nuerological basis
Defects in certain areas of the brain that are in correlation with BPSD symptoms (Depression, Aggression)
Acute medical Conditions (Pain is associated with aggressive behaviour in dementia)
Unmet Needs (Social needs)
Pre-existing personality, and psychiatric illness (Loss of inhibitory control, lifelong psychiatric disorders)
Caregiver Factors
Stress, burden, depression, lack of education about demention, communication issues, mismatch of expectations and dementia severity
Environmental Factors
Have difficulty processing enviornemnt, over/understimulation, lack of acitivty and structure, lakc of routines,