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Management of Behavioral and Psychological Symptoms of Dementia

  • Geriatric Disorders (JA Cheong, Section Editor)
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Abstract

Purpose of Review

We review non-pharmacological and pharmacological approaches to managing behavioral and psychological symptoms of dementia (BPSD). We examine methods for assessment and evidence for interventions, focusing on recent findings and innovations. Finally, we recommend an algorithm for management of BPSD.

Recent Findings

Training of formal caregivers is the most effective intervention for BPSD; other non-pharmacological interventions are also beneficial. Antidepressants and antipsychotics remain a mainstay of pharmacological treatment for BPSD. There is limited evidence supporting the use of stimulants, cognitive enhancers, dextromethorphan/quinidine, benzodiazepines, anticonvulsants, and pimavanserin.

Summary

The management of BPSD is highly individualized. Following thorough assessment, the initial step is addressing contributing medical problems. Non-pharmacological interventions should be tried prior to pharmacological interventions. Antipsychotics should be prescribed only when behaviors pose a significant safety risk or if the person with dementia is very distressed. New approaches will be needed to address an increasing population of people with dementia.

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  1. University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI, 53726, USA

    Laurel J. Bessey & Art Walaszek

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  1. Laurel J. Bessey
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Correspondence to Laurel J. Bessey.

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Laurel J. Bessey declares no potential conflicts of interest.

Art Walaszek reports speakers fees from Advocate Lutheran General Hospital, United Way (Madison, WI), University of Wisconsin-Parkside, Medical College of Wisconsin, and Wisconsin Association of Medical Directors. Dr. Walaszek reports an advance on royalties from American Psychiatric Association Publishing, is a core co-leader for National Institute of Ageing, and acted as PI and Co-PI on two grants for US Administration for Community Living.

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Bessey, L.J., Walaszek, A. Management of Behavioral and Psychological Symptoms of Dementia. Curr Psychiatry Rep 21, 66 (2019). https://doi.org/10.1007/s11920-019-1049-5

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