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Behavioural and Psychological Symptoms of Dementia (BSPD) and Management

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry

Abstract

The behavioural and psychological symptoms in dementia (BSPD) could be intrinsic to the disorder or occur across multiple diagnoses, for example, in primary psychiatric illness, chronic alcoholism, cerebral disorder (cerebral infarction), cerebrovascular disease, cerebral tumour and normal pressure hydrocephalus. The relationship between dementia and dementia-related behaviours remains unclear. There is a marked variation in their occurrence. Neurotransmitter abnormalities have been associated with behavioural symptoms. Most behavioural disturbances are possibly associated with the degree of dementia. Dementing disorders are accompanied by dangerous, disruptive, distressing and disturbing behaviours. BPSD consists of many symptoms, and they often occur in symptom clusters and recognized as subsyndromes or subsyndromal clusters. This review provides an overview of the behavioural and psychological symptoms of dementia and their clinical management.

Keywords

Behavioural and psychological symptoms in dementia Neurotransmitter abnormalities Subsyndromes or subsyndromal clusters Cholinesterase inhibitors Antipsychotics 

References

  1. 1.
    Rutter M, Graham P. The reliability and validity of the psychiatric assessment of the child. Interview with child. Br J Psychiatry. 1968;114:563–579.CrossRefPubMedGoogle Scholar
  2. 2.
    Finkel SL, Costa e Silva J, Cohen G, Miller S, Sartorius N. Behavioural and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. Internat psychiatry. 1997;8(3Suppl): S497–500.Google Scholar
  3. 3.
    Swearer JM, Hople NE, Kane KJ, Drachman DA. Predicting aberrant behaviour in Alzheimer’s disease. Neuropsychiat Neuropsychol Behav Neurol. 1996;9:162–170.Google Scholar
  4. 4.
    Nagaratnam N, Lewis–Jones M, Scott D, Palazzi L. Behavioural and psychiatric manifestations in dementia patients in a community: caregiver burden and outcome. Alz Dis Ass Dis. 1998;12:330–334.CrossRefGoogle Scholar
  5. 5.
    Swearer J, Drachman D, O’Donnel. Troublesome and destructive behaviours in dementia. J Am Gerriatr Soc. 1988;36:784–90CrossRefGoogle Scholar
  6. 6.
    Burns A, Jacoby R, Levy L. Psychiatric phenomena in Alzheimer’s disease 1. disorders of thought content. Br J Psychiatry. 1990; 157: 72–77.CrossRefPubMedGoogle Scholar
  7. 7.
    Hamel M,Gold DP, Andres D Reis M, Dastoor D,Graner H, et al. Predictions and consequences of aggressive behaviour by community based dementia patients. Gerolontologist. 1990;30:206–211.CrossRefGoogle Scholar
  8. 8.
    Nagaratnam N, Nagaratnam K. Psychiatric and behavioral aspects of dementia of the Binswanger type. Amer J Alz dis. 1998; 13:173–179Google Scholar
  9. 9.
    Sim M, Sussman I. Alzheimer’s disease: its natural history and differential diagnosis. J Nerv Ment Dis. 1962;135:489–499.CrossRefPubMedGoogle Scholar
  10. 10.
    Rubin EH, Drevets W, Burke WJ. The nature of psychiatric symptoms in senile dementia of the Alzheimer’s type. J Geriatr Psychiatry Neurol. 1988;1:16–20.PubMedGoogle Scholar
  11. 11.
    Rabins PV, Mace NL, Lucas MJ. The impact of dementia in the family. JAMA. 1982;248:333–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Rosin AJ. The physical and behavioural complex of dementia. Gerontology. 1977;23:37–46.CrossRefPubMedGoogle Scholar
  13. 13.
    Cohen-Mansfield J, Werner P, Marx MS. Screaming in nursing homes residents. J Am Geriatr Soc. 1990;38:785–92.CrossRefPubMedGoogle Scholar
  14. 14.
    Greenway BS, Marin DB, Siverman SM. Serotonergic treatment of screaming and banging in dementia. Lancet. 1986;146–5.Google Scholar
  15. 15.
    Senanarong V, Cummings JL, Fairbanks L, Mega M, Masterman DM, O’Connor SM, et al. Agitation in Alzheimer’s disease is a manifestation of frontal lobe dysfunction. Dement Geriatr Cogn Disord. 2004;17:14–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Gorman DG, Cummings JL. Organic delusional syndrome. Semin Neurol. 1990; 10:219–3.CrossRefGoogle Scholar
  17. 17.
    Minger SL, Esiri MM, McDonald B, Keane J, Carter J, Hope T, et al. Cholinergic effects contributor to behavioural disturbance in patients with dementia. Neurology. 2000;66(10):1460–7.CrossRefGoogle Scholar
  18. 18.
    Tekin S, Mega MS, Masterman DL, Chow T, Garakian J, Vinters HV, et al. Orbito-frontal and anterior cingulate cortex. Neurofibrillary tangles burden is associated with neurofibrillary tangles greater burden of in the orbitofrontal cortex. Ann Neurol. 2001;49:355–361.CrossRefPubMedGoogle Scholar
  19. 19.
    Cummings JL. Organic delusions phenomenology anatomical evaluation and review. Br J Psychiatry. 1985;146:184–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Sweet RA, Nimgoankar VL, Delvin B, Lopez OL, DiKosky ST. Increase familial risk of the psychotic phenotype of Alzheimer’s disease. Neurology. 2002;58:907–911.CrossRefPubMedGoogle Scholar
  21. 21.
    Low LF, Brodaty H, Draper B. History of premorbid personality and behavioural and psychological symptoms of dementia in nursing home residents. Int J Geriatr Psychiatry. 2002;17:779–83.CrossRefPubMedGoogle Scholar
  22. 22.
    Kolanowski AM, Whall AL. Life span perspective of personality in dementia. Image J Nurs Sch. 1996;28:315–20.CrossRefPubMedGoogle Scholar
  23. 23.
    Nagaratnam N, Pathmanathan N. Behavioral and psychiatric aspects of silent cerebral infarction. Brit J Clin Pract 1997;51: 160–163.PubMedGoogle Scholar
  24. 24.
    Nagaratnam N, Ting A, Jolley D. Thalamic tumour presenting as frontal lobe dysfunction.Int J Clin Pract 2001;55: 492–493.PubMedGoogle Scholar
  25. 25.
    Mega S, Cummings JL, Fiorello T,Gornbein J. The spectrum of behavioural changes in Alzheimer’s disease. Neurology. 1996;46:130–135.CrossRefPubMedGoogle Scholar
  26. 26.
    Patterson MB, Scnell AH, Martin RJ, Mendez MF, Smyth KA, Whitehouse PJ. Assessment of behavioral and affective symptoms in Alzheimer’s disease. J Geriatr Psychiatry Neurol. 1990;3(1):21–30.CrossRefPubMedGoogle Scholar
  27. 27.
    Gilley DW, Whalen ME,Wilson RS,Bennett DA, Evans DA. Hallucinations and associated factors in Alzheimer’s disease. L Neuropsychiatr Clin Neurosci 1991;3:371–376.CrossRefGoogle Scholar
  28. 28.
    Lazarus IW, Newton N,Cohler B, Lesser J, Schweon C. Frequency and presentation of depressive symptoms in patients with degenerative dementia. Am J Psychiatry 1987;144:41–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Patel V, Hope T. Aggressive behaviour in elderly people with dementia. A review. Int J Geriatr Psychiatry 1993;8:457–472.CrossRefGoogle Scholar
  30. 30.
    Albert SM. The nature of wandering in dementia: Guttman scaling analysis of an empirical classification scheme. Int J Geriat Psychiatry. 1992;7:783–787.CrossRefGoogle Scholar
  31. 31.
    Ryan DP, Tainsh SMM, Kolodny V, Lendrum BL, Fisher RH. Noise-making amongst the elderly in long-term care. Gerontologist. 1988;28(3):369–371.CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen-Mansfield J,Werner P. Typology of disruptive vocalizations in older persons suffering from dementia. Int J Geriatr Psychiatry 1997;12:1079–1091.CrossRefPubMedGoogle Scholar
  33. 33.
    Nagaratnam N, Patel I, Whelan C. Screaming shrieking and muttering: the noise makers amongst dementia patients. Arch Gerontol Geriatr. 2003;36:247–258.CrossRefPubMedGoogle Scholar
  34. 34.
    Hope T, Keene J, Fairburn C, McShane R, Jacoby R. Behaviour changes in dementia 2. Are there behavioural syndromes? Int J Geriatr Psychiatry. 1997;12:1074–1078.CrossRefPubMedGoogle Scholar
  35. 35.
    Nagaratnam N, Nagaratnam K. Screaming in dementia. Geriatrics Aging. 2005;8(3):48–57Google Scholar
  36. 36.
    Alzheimer A Ober eine eigenartige Erkrankung der Himrinde. Allg Z Psychiatr Gericht Med. 1907; 64: 146–148 (translation).Google Scholar
  37. 37.
    McKeith I,Faibairn A, Perry R,Thompson P, Perry E. Neuroleptic sensitivity in patients with senile dementia of the Lewy body type. Br Med J. 1992;305: 673–675CrossRefGoogle Scholar
  38. 38.
    Ballard CG, O’Brien JT, Reichelt K, Perry EK. Aromatherapy as a safe and effective treatment in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. J Clin Psychiatry. 2002;6:553–8.CrossRefGoogle Scholar
  39. 39.
    Desai AK, Grossberg GT. Recognition and management of behavioural disturbances in dementia.: primary care companion. J Clin Psychiatry. 2001,3:93–109.Google Scholar
  40. 40.
    Perry EK, Haroutunian V, Davis KL, Levy R, Lantos P, Eaggers S, et al. Neocortical cholinergic activities differentiate Lewy body dementia from classical Alzheimer’s disease. Neuroreport. 1994;5:747–749.CrossRefPubMedGoogle Scholar
  41. 41.
    McKeith I, Del Ser T, Spano P, Emre M, Wiesnes K, Anand R, et al. Efficacy of rivastigmine in dementia with Lewy bodies: a randomized double-blind placebo-controlled international study. Lancet. ;356:2031–2036.Google Scholar
  42. 42.
    Liberini P, Valerio A, Memo M, Spano PF. Lewy-body dementia and responsiveness to cholinesterase inhibitors: a paradigm for heterogeneity of Alzheimer’s disease? Trends Pharmacol Sci. 1996;17:155–160.CrossRefPubMedGoogle Scholar
  43. 43.
    Cummings JL. Cholinesterase inhibitors: a new class of psychotropic compounds. Am J Psychiatry. 2000;157:4–15CrossRefPubMedGoogle Scholar
  44. 44.
    Gautjier S, Feldman H, Hecker J, Velas B, Ames D, Subbiah P,et al. Efficiency of donzepil on behavioural symptoms in patients with moderate to severe Alzheimer’s disease. Int Psychiar. 2002;14(4):389–404.Google Scholar
  45. 45.
    Lott AD, McElroy SL, Keys MA. Valproate in the treatment of behavioural agitation in elderly patients with dementia. J Neuropsychiat Clin Neurosci. 1994;7:314–9.Google Scholar
  46. 46.
    Tariot PN, Erb R, Podgorski CA, Cox C, Patel S, Jakimovich L, et al. Efficacy and tolerability of carbazepine for agitation and aggression in dementia. Am J Psychiatry. 1998;155:54–61.CrossRefPubMedGoogle Scholar
  47. 47.
    Porsteinisson AP, Tariot PN, Erb R, Cox C, Smith E, Jakimovich L, et al. Placebo-controlled study of divalproex sodium for agitation in dementia. Amer J Geriatr Psychiatry. 1998;15:1512–1526.Google Scholar
  48. 48.
    Glass CA, Schneider L, Farlow MR. Optimal management of behavioural disorders associated with dementia. Drugs Aging. 1997;10:95–106.CrossRefGoogle Scholar
  49. 49.
    Lanctot KL, Best TS, Mittmann N, Liu BA, Oh PI, Einarson TR, et al. Efficacy and safety of neuroleptics in behavioural disorders associated with dementia. J Clin Psychiatry. 1998;59:550–561.CrossRefPubMedGoogle Scholar
  50. 50.
    Cumming JL, Vinters H, Felix J eds. The neuropsychiatry of Alzheimer’s disease and related dementias. London:Martin Dunnitz, 2003;23–32.Google Scholar
  51. 51.
    Byerly MI, Weber MT, Brooks DL, Snow LR, Worley MA, Lesocouflair E. et al. Antipsychotic medications on the elderly, effect on cognitive implications for use. Drugs Aging. 2001;18:45–61.CrossRefPubMedGoogle Scholar
  52. 52.
    Kopala LC, Honer WG. The use of risperidone in severely demented patients with persistent vocalizations. Int J Geriatr Psychiatry. 1997;12:73–77.CrossRefPubMedGoogle Scholar
  53. 53.
    DeDeyn PP, Rabheru K, Rasmussen A, Bocksberger JP, Dautzenberg PL,Eriksson S, et al. A randomized trial of risperidone, placebo and haloperidol for behavioral symptoms in dementia. Neurology. 1999;53:946–955.CrossRefGoogle Scholar
  54. 54.
    Katz IR, Jeste DV, Mintzer JE, Clyde C, Napolitano J, Brecher M. Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized: double-blind trial. J Clin. 1999;60:107–113.Google Scholar
  55. 55.
    Madhusoodanan S, Brenner R, Cohen CI. Role of atypical antipsychotics in the treatment of psychosis and agitation associated with dementia. CNS Drugs. 1999;12:135–50.CrossRefGoogle Scholar
  56. 56.
    Lyketos CG, Sheppard JM, Steele CD, Kopunek S, Stenberg M, Baker AS, et al. Randomizes placebo-controlled, double-blind clinical trial of sertraline in the treatment of depression complicating Alzheimer’s disease. Initial results from the depression and Alzheimer disease study. Am J Psychiatry. 2000;157:1686–1689.CrossRefGoogle Scholar
  57. 57.
    Herman N, Lanctot KL. From transmitters to treatment: the Pharmacotherapy of behavioural disturbances in dementia. Can J Psychiatry. 1997;42 (1 Suppl)S51–64.Google Scholar
  58. 58.
    Nyth AL, Goffries CG. The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: a Nordic multicentre study. Br J Psychiatry.1990;157:894–901.CrossRefPubMedGoogle Scholar
  59. 59.
    Coccaro EE, Siever LJ. Second generation antidepressants: a comparative. J Clin Pharmacol. 1985;25:241260.CrossRefGoogle Scholar
  60. 60.
    Greenwald BS, Marin DB, Siverman SM. Serotonergic treatment of screaming and banging in dementia. Lancet. 1986;1464–1465.Google Scholar
  61. 61.
    Pasion RC, Kirby SG. Trazodone for screaming. Lancet.1993;341:970.CrossRefPubMedGoogle Scholar
  62. 62.
    Gabryelewicz T. Pharmacological treatment of behavioural symptoms in dementia patients. Pzegl Lek. 2014;71(4):215–20.Google Scholar
  63. 63.
    Hermann N, Lanctot K, Naraiyo C. Behavioural disorders in demented elderly patients. Current issues in pharmacotherapy. CNS Drugs. 1996;6:280–300.CrossRefGoogle Scholar
  64. 64.
    Deutsch LH, Bylsma FW, Rovner B, Steele C, Folstein M. Psychosis and physical aggression in probable Alzheimer’s disease. Am J Psychiatry. 1991;148:1159–1163.CrossRefPubMedGoogle Scholar
  65. 65.
    Kar N. Behavioural and Psychological Symptoms of dementia. In :Kr N, Jolly D, Misra N.editors Handbook of Dementia. Hyderbad: Paras MedicalPublisher 2005 .pp 54–76.Google Scholar
  66. 66.
    Wynn ZJ, Cummings JL. Cholinesterase inhibitors and neuropsychiatric manifestations of Alzheimer’s disease. Dement Geriatr Cogn Disord. 2004;17:100–8.CrossRefPubMedGoogle Scholar
  67. 67.
    Kar N. Behavioural and psychological symptoms of dementia and their management. Ind J Psychiatry. 2009;51(suppl1) S77–S86.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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