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1
Kamoga, Ronald, Vincent Mubangizi, Judith Owokuhaisa, Moses Muwanguzi, Sylivia Natakunda, and Godfrey Zari Rukundo. "Behavioral and Psychological Symptoms of Dementia: Prevalence, Symptom Severity, and Caregiver Distress in South-Western Uganda—A Quantitative Cross-Sectional Study." International Journal of Environmental Research and Public Health 20, no. 3 (January 28, 2023): 2336. http://dx.doi.org/10.3390/ijerph20032336.
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The purpose of the study was to investigate behavioral and psychological symptoms (BPSD) prevalence, severity, and distress experienced by caregivers of people living with dementia (PLWD). A cross-sectional, population-based study was conducted in a rural area in southwestern Uganda. A Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to determine the presence of BPSD as perceived by caregivers of PLWD. We carried out both descriptive and inferential data analysis. A total of 175 caregivers of PLWD were enrolled in this study. Among PLWD, 99% had presented BPSD in the past month. Hallucinations (75%) and dysphoria/depression (81%) were the two BPSD that occurred most frequently. Most participants (70%) stated that PLWD experienced hallucinations of significant severity. Aberrant motor activity was reported by 60% of the participants as the type of BPSD that caused severe distress. There was a high positive correlation (0.82) between the total severity score and total distress scores. Interventions aimed at addressing dysphoria and hallucinations may be essential for the reduction of caregiver distress. These findings point to the need for promoting early screening for BPSDs and the provision of support to caregivers.
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Chang, Chia-Hui, Yung Ming, Tsung-Hung Chang, Yea-Yin Yen, and Shou-Jen Lan. "The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors." International Journal of Environmental Research and Public Health 17, no. 16 (August 18, 2020): 6009. http://dx.doi.org/10.3390/ijerph17166009.
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This study was to evaluate the utilization of long-term care service resources by caregivers of patients with dementia (PWD) and to determine affecting factors. In this cross-sectional study, a total of 100 dyads were enrolled and caregivers responded to the questionnaires. We found 40% of caregivers not using any care resources. Between those caregivers using and not-using care resources, we found differences (p < 0.05) in their health status and living conditions; the difference (p < 0.05) was also found in patients’ behavior and psychological symptoms of dementia (BPSD). The frequency of BPSD (OR = 1.045, p = 0.016, 95% CI = 1.001–1.083) and the living conditions (OR = 3.519, p = 0.007, 95% CI = 1.414–8.759) were related to their use of care resources. Particular BPSDs, such as anxiety or restlessness, throwaway food, aggressive behavior, tearing of clothes, and sexual harassment of patients were related to the caregivers’ use of care resources (p < 0.01). Health professionals have to evaluate the patients’ BPSD and identify the caregivers’ essential needs. Individualized medical care and BPSD-related care resources should be provided for patients and caregivers for taking off their care burden and improving patient care.
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Nevoral, Jan, Yaroslav Kolinko, Jiří Moravec, Tereza Žalmanová, Kristýna Hošková, Šárka Prokešová, Pavel Klein, et al. "Long-term exposure to very low doses of bisphenol S affects female reproduction." Reproduction 156, no. 1 (July 2018): 47–57. http://dx.doi.org/10.1530/rep-18-0092.
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Bisphenols belong to the endocrine disruptors, affecting reproduction even in extremely low doses. Bisphenol S (BPS) has become widely used as a substitute for the earlier-used bisphenol A; however, its harmlessness is questionable. The aim of this study was to evaluate the effect of BPS on folliculogenesis and oocyte quality afterin vivoexposure to low doses of BPS. Four-week-old ICR females (n = 16 in each experimental group) were exposed to vehicle control (VC), BPS1 (0.001 ng BPS.g/bw/day), BPS2 (0.1 ng.g/bw/day), BPS3 (10 ng.g/bw/day) and BPS4 (100 ng.g/bw/day) for 4 weeks. Ovaries were subjected to stereology and nano liquid chromatography-mass spectrometry (LC/MS). Simultaneously, metaphase II oocytes were obtained after pregnant mare serum gonadotrophin and human chorionic gonadotrophin administration, followed by immunostaining. In particular, mating and two-cell embryo flushing were performed. We observed that BPS decreases the amount of ovarian follicles and BPS2 (0.1 ng.g/bw/day) affects the volume of antral follicles. Accordingly, ovarian proteome is affected after BPS2 treatment. While BPS2 dosing results mainly in cytoskeletal damage in matured oocytes, the effects of BPS3 and BPS4 seem to be due instead to epigenetic alterations in oocytes. Arguably, these changes lead to observed affection ofin vivofertilization rate after BPS3 and BPS4 treatment. BPS significantly affects female reproduction astoundingly in extremely low doses. These findings underline the necessity to assess the risk of ongoing BPS exposure for public health.
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Manini, Arianna, Michela Brambilla, Laura Maggiore, Simone Pomati, and Leonardo Pantoni. "The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia." Neurological Sciences 42, no. 3 (January 14, 2021): 825–33. http://dx.doi.org/10.1007/s10072-020-05035-8.
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Abstract Background During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people’s lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Methods Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients’ BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. Results A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. Conclusion This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.
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Jao, Ying-Ling, Julian Wang, Yo-Jen Liao, Diane Berish, Kimberly Van Haitsma, and Marie Boltz. "Effects of Ambient Bright Light on Neurobehavioral Symptoms in Dementia: A Systematic Review." Innovation in Aging 4, Supplement_1 (December 1, 2020): 162. http://dx.doi.org/10.1093/geroni/igaa057.527.
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Abstract Most persons living with dementia (PLwD) experience behavioral and psychological symptoms of distress in dementia (BPSDs). Despite increased utilization of bright light to improve BPSDs, the evidence of effectiveness and dosage using ambient light has not been comprehensively examined. This review synthesized research evidence on the effect of ambient light on BPSD in PLwD. A literature search conducted in Scopus, PubMed, CINAHL, and Web of Science included keywords: dementia, bright light, ambient light, indirect light, behavior symptoms, agitation, wandering, depression, aggression, and apathy. Original studies that examined the effect of ambient light on BPSDs were included. Six studies were identified. Sample size ranged from 6 to 189. Lighting delivery methods included a lighting table and ceiling-mounted fixtures in public areas and/or participant’s bedroom. Lighting intensity ranged from 1,000-3,000 lux, color temperature ranged from bluish white to warm white, and exposure duration ranged from 4 to 24 hours a day. PLwD with higher light exposure showed more pleasure and alertness. Ambient bright lighting showed mixed results in reducing agitation with one study reporting increased agitation. Three out of four studies showed positive effects upon depressive symptoms. Ambient bright light positively impacted pleasure and alertness. Mixed results on agitation and depressive symptoms may be explained by differences in illuminance, color, duration, and targeted lighting positions. Further studies are needed to confirm the positive effects of ambient light on BPSD. Accurate lighting exposure measurements related to spectral compositions and dosage for individual PLwD would help explain the underlying relationships between lighting and BPSD.
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Zheng, Zhanjie, Jindong Wang, Lei Yi, Hui Yu, Lingli Kong, Weizhen Cui, Hong Chen, and Chunxia Wang. "Correlation between Behavioural and Psychological Symptoms of Alzheimer Type Dementia and Plasma Homocysteine Concentration." BioMed Research International 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/383494.
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The relationship between plasma homocysteine and behavioral and psychological symptoms of dementia (BPSD) has not been specifically investigated in previous research. In this study, we compared plasma homocysteine (Hcy) among 40 Alzheimer’s disease (AD) patients with BPSD, 37 AD patients without BPSD, and 39 healthy controls. Our results evidenced that the plasma homocysteine levels in AD patients with BPSD and without BPSD were higher than healthy controls and that the plasma homocysteine concentration in AD patients with BPSD was the highest among the three groups. Significant correlation between plasma homocysteine concentration and cognitive decline and duration of dementia was observed, but there was no correlation between BPSD and cognitive dysfunction or duration of dementia. In conclusion, this study showed for the first time that BPSD were associated with plasma homocysteine concentration in Alzheimer's dementia, and the results supported that hyperhomocysteine may take part in the pathogenesis of BPSD.
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Connelly, Caitlin, Kyungmin Kim, Yin Liu, and Steven Zarit. "Temporal Patterns of Daily Behavioral and Psychological Symptoms of Dementia Throughout the Day." Innovation in Aging 5, Supplement_1 (December 1, 2021): 53–54. http://dx.doi.org/10.1093/geroni/igab046.204.
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Abstract Behavioral and psychological symptoms of dementia (BPSD) are taxing for both the person with dementia (PWD) and their family caregivers. Yet, little is known about how BPSD fluctuates throughout the day (i.e., morning, daytime, evening, and night; e.g., sundowning) and how caregivers perceive BPSD at different times of the day. Using 8-day daily diary data from 173 family caregivers whose relatives were using Adult Day Services (ADS), this study investigated temporal patterns of BPSD and caregivers’ stress responses to BPSD throughout the day. Overall, the number of BPSD was highest in the evening, and caregivers’ stress reactivity to BPSD increased throughout the phases of the day (i.e., most stressful at night). However, caregivers showed lower reactivity to BPSD in the mornings and at night on days when the PWD used ADS. Our findings about fluctuations of (caregiver reactions to) BPSD throughout the day suggest target windows for just-in-time adaptive intervention.
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Scassellati, Catia, Miriam Ciani, Carlo Maj, Cristina Geroldi, Orazio Zanetti, Massimo Gennarelli, and Cristian Bonvicini. "Behavioral and Psychological Symptoms of Dementia (BPSD): Clinical Characterization and Genetic Correlates in an Italian Alzheimer’s Disease Cohort." Journal of Personalized Medicine 10, no. 3 (August 14, 2020): 90. http://dx.doi.org/10.3390/jpm10030090.
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Background: The occurrence of Behavioral and Psychological Symptoms of Dementia (BPSD) in Alzheimer’s Disease (AD) patients hampers the clinical management and exacerbates the burden for caregivers. The definition of the clinical distribution of BPSD symptoms, and the extent to which symptoms are genetically determined, are still open to debate. Moreover, genetic factors that underline BPSD symptoms still need to be identified. Purpose. To characterize our Italian AD cohort according to specific BPSD symptoms as well as to endophenotypes. To evaluate the associations between the considered BPSD traits and COMT, MTHFR, and APOE genetic variants. Methods. AD patients (n = 362) underwent neuropsychological examination and genotyping. BPSD were assessed with the Neuropsychiatric Inventory scale. Results. APOE and MTHFR variants were significantly associated with specific single BPSD symptoms. Furthermore, “Psychosis” and “Hyperactivity” resulted in the most severe endophenotypes, with APOE and MTHFR implicated as both single risk factors and “genexgene” interactions. Conclusions. We strongly suggest the combined use of both BPSD single symptoms/endophenotypes and the “genexgene” interactions as valid strategies for expanding the knowledge about the BPSD aetiopathogenetic mechanisms.
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Shah, Ajit. "What Are the Necessary Characteristics of a Behavioral and Psychological Symptoms of Dementia Rating Scale?" International Psychogeriatrics 12, S1 (July 2000): 205–9. http://dx.doi.org/10.1017/s1041610200007043.
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Dementia encompasses both cognitive and noncognitive domains. Noncognitive symptoms include disorders of behavior, personality, mood, thought content, and perception and impaired functional ability. Behavioral, personality, mood, and thought content disorders have been labeled behavioral and psychological symptoms of dementia (BPSD) following a previous International Psychogeriatric Association consensus conference. Traditionally, BPSD have been poorly studied for several reasons, including the lack of importance attached to cognition in the diagnosis of dementia, the assumption that BPSD are secondary to cognitive and personality changes, the difficulty of accurately defining BPSD, and the paucity of standardized instruments to measure BPSD. Historically, all BPSD tended to be studied together under one broad umbrella and thus older data on individual BPSD are limited. Differing definitions, patient populations, study designs, data collection methods, measurement instruments, and methodologic issues influence the prevalence of the various BPSD reported in different studies, making comparisons between studies difficult.
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Marziliano, Allison, Alex Makhnevich, Edith Burns, Michael Diefenbach, and Liron Sinvani. "BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD) IN HOSPITALIZED OLDER ADULTS WITH AD/ADRD." Innovation in Aging 6, Supplement_1 (November 1, 2022): 381–82. http://dx.doi.org/10.1093/geroni/igac059.1506.
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Abstract The epidemiology of Behavioral and Psychological Symptoms of Dementia (BPSD) in hospitalized older adults with Alzheimer’s Disease (AD) and AD-related dementias (ADRD) has not been well-characterized. The purpose of this abstract is to examine the prevalence, patient-level factors and hospital outcomes associated with BPSD in hospitalized older adults with AD/ADRD. Data was extracted from the electronic health record (EHR) of older adults (aged 65+ years) with AD/ADRD, admitted to one of 7 hospitals in the greater New York metropolitan area during 2019. Three independent coders reviewed the EHR and recorded the presence or absence of the 11 domains of the Neuropsychiatric Inventory (NPI), a validated measure of BPSD. Of N = 1,865 hospitalized older adults with AD/ADRD, 1,564 had BPSD (prevalence = 83.9%). The most commonly reported BPSD were agitation (72.3%) and anxiety (17.7%). Older age (M = 84.6, SD = 7.6 versus M = 82.4, SD = 7.8, p = .000) and antipsychotic medication use prior to hospital admission (91% of the older adults who used home antipsychotics had BPSD, p = 000) was associated with BPSD. With regard to hospital outcomes, BPSD was associated with: increased mortality (of those who died, 90.6% had BPSD, p = .006), and increased likelihood of readmission to the hospital within 30 days of discharge (of those readmitted, 89.3% had BPSD, p = .007). Given its high prevalence and associated poor outcomes, recognizing and managing BPSD in hospitalized patients with AD/ADRD is critical to improving quality of care for this vulnerable population.
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Otsuka, Shizuka, Akiko Hamahata, and Masaki Abe. "BPSD and the challenges faced by nurses." Working with Older People 24, no. 1 (January 6, 2020): 39–48. http://dx.doi.org/10.1108/wwop-10-2019-0029.
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Purpose The purpose of this paper is to provide an overview of published literature on behavioural and psychological symptoms of dementia (BPSD) nursing in Japan and to highlight challenges that need to be resolved. Design/methodology/approach The criteria for retrieval of literature were as follows: a BPSD study conducted by a nurse in Japan, and it must have been published. Papers without conference proceedings and peer reviews and literature without English titles and abstracts were excluded. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) was referenced. Findings Based on the analysis of 20 studies meeting the criteria, nurses tended to manage BPSD when all three of the following were clearly defined: attempts to understand BPSD, the provision of nursing intervention to improve the quality of care and clarification of the perception of BPSD. There were eight studies that implemented surveys considered to be helpful for nurses to understand BPSD with the aim of clarifying the symptomatic factors, meaning of each behaviour, etc. In the eight studies, nurses directly coped with BPSD in various ways. Four studies reported on how nurses perceive the associated behaviours and symptoms of BPSD patients. Originality/value This study suggests that not only implementing interventions but also aiming at improving nurses’ understanding of BPSD and their level of knowledge are crucial to promote BPSD nursing in Japan.
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Feast, Alexandra, Esme Moniz-Cook, Charlotte Stoner, Georgina Charlesworth, and Martin Orrell. "A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being." International Psychogeriatrics 28, no. 11 (June 27, 2016): 1761–74. http://dx.doi.org/10.1017/s1041610216000922.
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ABSTRACTBackground:Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.Methods:Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).Results:Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.Conclusions:The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.
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Loi, Samantha M., and Nicola T. Lautenschlager. "Investigating the current methods of assessing behavioral and psychological symptoms in residential aged care facilities in a metropolitan city." International Psychogeriatrics 29, no. 5 (December 21, 2016): 855–58. http://dx.doi.org/10.1017/s104161021600226x.
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ABSTRACTUp to 90% of people with dementia living in residential aged care facilities (RACFs) display behavioral and psychological symptoms of dementia (BPSD), and these are associated with poorer quality of life and increased morbidity and mortality. In order to implement appropriate interventions, it is important to understand the symptoms in more detail. Despite the availability of BPSD assessment tools, it is unknown what the current practice of monitoring of BPSD in RACFs. We sought to investigate the current BPSD assessment tools being used in RACFs and explore different stakeholders’ views on current practices. A cross-sectional convenience sample of 21 clinicians were identified and administered a questionnaire.Old age psychiatrists, aged psychiatry clinicians, behavior management teams and RACF staff completed the questionnaires. Clinicians reported that objective consistent information about BPSD were important for recommending and implementing pharmacological and non-pharmacological strategies for BPSD; however, the use of validated BPSD assessments in RACFs was not a usual part of clinical practice. RACF staff stated the major barrier to assessment of BPSD was lack of time. Alternate methods of assessing BPSD which consider preferences from clinicians and RACF staff should be further investigated. Modern technology which can allow “real time” assessment may be a solution.
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Kim, Dayeong, Young-Rim Choi, Ye-Na Lee, Won-Hee Park, and Sung-Ok Chang. "How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?" International Journal of Environmental Research and Public Health 19, no. 17 (August 23, 2022): 10493. http://dx.doi.org/10.3390/ijerph191710493.
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Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.
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Hashimoto, Mamoru, Yusuke Yatabe, Tomohisa Ishikawa, Ryuji Fukuhara, Keiichiro Kaneda, Kazuki Honda, Seiji Yuki, et al. "Relationship between Dementia Severity and Behavioral and Psychological Symptoms of Dementia in Dementia with Lewy Bodies and Alzheimer's Disease Patients." Dementia and Geriatric Cognitive Disorders Extra 5, no. 2 (June 6, 2015): 244–52. http://dx.doi.org/10.1159/000381800.
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Background/Aims: Behavioral and psychological symptoms of dementia (BPSD) are common in the clinical manifestation of dementia. Although most patients with dementia exhibit some BPSD during the course of the illness, the association of BPSD with the stage of dementia remains unclear. It was the aim of this study to evaluate the impact of severity of dementia on the expression of BPSD in patients with dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Methods: Ninety-seven patients with DLB and 393 patients with AD were recruited from 8 dementia clinics across Japan. BPSD were assessed by the Neuropsychiatric Inventory (NPI). A relationship between BPSD and dementia stage classified by the Clinical Dementia Rating (CDR) in each type of dementia was assessed. Results: No significant difference was seen in NPI total score across CDR staging in the DLB group. On the other hand, the NPI total score significantly increased with dementia stage in the AD group. Conclusion: The relationship of dementia stage with the expression of BPSD was different according to the type of dementia. BPSD and dementia stage were correlated in AD subjects, in whom psychiatric symptoms increase as the disease progresses, but not in DLB subjects.
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Altomari, Natalia, Francesco Bruno, Valentina Laganà, Nicoletta Smirne, Rosanna Colao, Sabrina Curcio, Raffaele Di Lorenzo, et al. "A Comparison of Behavioral and Psychological Symptoms of Dementia (BPSD) and BPSD Sub-Syndromes in Early-Onset and Late-Onset Alzheimer’s Disease." Journal of Alzheimer's Disease 85, no. 2 (January 18, 2022): 691–99. http://dx.doi.org/10.3233/jad-215061.
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Background: Behavioral and psychological symptoms of dementia (BPSD) have a large impact on the quality of life of patients with Alzheimer’s disease (AD). Few studies have compared BPSD between early-onset (EOAD) and late-onset (LOAD) patients, finding conflicting results. Objective: The aims of this study were to: 1) characterize the presence, overall prevalence, and time of occurrence of BPSD in EOAD versus LOAD; 2) estimate the prevalence over time and severity of each BPSD in EOAD versus LOAD in three stages: pre-T0 (before the onset of the disease), T0 (from onset to 5 years), and T1 (from 5 years onwards); 3) track the manifestation of BPSD sub-syndromes (i.e., hyperactivity, psychosis, affective, and apathy) in EOAD versus LOAD at T0 and T1. Methods: The sample includes 1,538 LOAD and 387 EOAD diagnosed from 1996 to 2018. Comprehensive assessment batteries, including the Neuropsychiatric Inventory (NPI), were administered at the first medical assessment and at different follow-up period. Results: The overall prevalence for the most of BPSD was significantly higher in EOAD compared to LOAD whereas most BPSD appeared significantly later in EOAD patients. Between the two groups, from pre-T0 to T1 we recorded a different pattern of BPSD prevalence over time as well as for BPSD sub-syndromes at T0 and T1. Results on severity of BPSD did not show significant differences. Conclusion: EOAD and LOAD represent two different forms of a single entity not only from a neuropathological, cognitive, and functional level but also from a psychiatric point of view.
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Perkins, Rebekah, Elizabeth Cashdan, and Katherine Supiano. "A PILOT STUDY TO TEST METHODS FOR DATA COLLECTION ON NURSES CARING FOR RESIDENTS WITH DEMENTIA IN THE NURSING HOME." Innovation in Aging 3, Supplement_1 (November 2019): S451. http://dx.doi.org/10.1093/geroni/igz038.1691.
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Abstract Nurses draw from their experiences and intuition to detect changes in patient condition, patterns of patient behaviors, and evidence of distress. In the nursing home setting, nurses care for residents with dementia and manage challenging behavioral and psychological symptoms of dementia (BPSD), and may rely on informed intuition to assess and capably respond to such behaviors. To date, no observational method has been developed to discern nurse-resident interactions that identify expert nurses who effectively address BPSD. It is not known if or how nurses in this setting use intuition to make clinical judgments and decisions to manage BPSD events. Using an ethogram approach, we developed an observational tool and spot interview method to discern BPSD events, background and proximal factors and nurse responses to BPSD. Pilot observations took place over three nursing shifts to identify nurse-resident interactions during BPSD events using the observation tool. Nurse-resident interactions were followed by spot interviews with each nurse to clarify their responses to BPSD. Semi-structured interviews were conducted with nurse participants to further develop an interview guide and identify elements of nurse intuition. The pilot study affirmed the feasibility of gaining access to facilities with residents with BPSD, of nurse comfort with field observation and interviews, and established preliminary construct validity of the “expert nurse.” Verification of the utility of this observation and interview method permit further examination of effective nurse engagement with nursing home residents with BPSD, informs our understanding of nurse intuition and permits further exploration of the broader context of BPSD.
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Arthur, Paul B., Laura N. Gitlin, John A. Kairalla, and William C. Mann. "Relationship between the number of behavioral symptoms in dementia and caregiver distress: what is the tipping point?" International Psychogeriatrics 30, no. 8 (November 16, 2017): 1099–107. http://dx.doi.org/10.1017/s104161021700237x.
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ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise.Methods:Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress.Results:Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01).Conclusions:Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
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Cho, Eunhee, Sujin Kim, Sinwoo Hwang, Eunji Kwon, Seok-Jae Heo, Jun Hong Lee, Byoung Seok Ye, and Bada Kang. "Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy." Journal of Medical Internet Research 23, no. 10 (October 29, 2021): e29001. http://dx.doi.org/10.2196/29001.
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Background Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors—circadian rhythm–related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states—on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. Objective The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. Methods A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. Results Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day’s sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. Conclusions BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.
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Tiel, Chan, Felipe Kenji Sudo, Gilberto Sousa Alves, Letice Ericeira-Valente, Denise Madeira Moreira, Jerson Laks, and Eliasz Engelhardt. "Neuropsychiatric symptoms in Vascular Cognitive Impairment: A systematic review." Dementia & Neuropsychologia 9, no. 3 (September 2015): 230–36. http://dx.doi.org/10.1590/1980-57642015dn93000004.
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Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]). Objective: To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI). Methods: Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI). Results: A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD. Conclusion: The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.
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Mukherjee, Adreesh, Atanu Biswas, Arijit Roy, Samar Biswas, Goutam Gangopadhyay, and Shyamal Kumar Das. "Behavioural and Psychological Symptoms of Dementia: Correlates and Impact on Caregiver Distress." Dementia and Geriatric Cognitive Disorders Extra 7, no. 3 (November 1, 2017): 354–65. http://dx.doi.org/10.1159/000481568.
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Aims: To evaluate the behavioural and psychological symptoms of dementia (BPSD), to determine their correlation with types and stages of dementia and patient demographics, and to assess the impact on caregiver distress. Methods: This cross-sectional study recruited consecutive dementia patients and caregivers who attended our cognitive clinic. Standard criteria were used to classify types of dementia. BPSD were assessed with the Neuropsychiatric Inventory, and its distress scale was used for caregiver distress. Results: Of a total 107 patients, nearly all (99.1%) had at least one BPSD; 71% had ≥4 symptoms. Most frequent were apathy and agitation, followed by irritability, sleep and appetite disorders, and mood disorders; disinhibition and euphoria were least frequent. BPSD were less prominent with increasing age; males showed more agitation. Apathy and eating disorders were more prevalent in the rural community. BPSD were highest in frontotemporal dementia (FTD), followed by dementia with Lewy bodies (DLB), and least in vascular dementia. Hallucinations were more common in DLB, aberrant motor behaviour in FTD. All domains of BPSD, except for anxiety and euphoria, were more prominent with increasing severity of dementia. Increasing BPSD (except for euphoria) caused higher caregiver distress. Conclusion: BPSD are universally present, bear correlates with dementia type and severity, and cause significant caregiver distress.
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Eikelboom, Willem S., Michiel Coesmans, Rik Ossenkoppele, Esther van den Berg, and Janne M. Papma. "301 - The diagnostic and treatment challenges of behavioral and psychological symptoms in Alzheimer’s disease; a qualitative study in memory clinic practice." International Psychogeriatrics 32, S1 (October 2020): 57. http://dx.doi.org/10.1017/s104161022000201x.
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Introduction:Behavioral and psychological symptoms in dementia (BPSD) have great impact on the daily lives of Alzheimer’s disease (AD) patients and their caregivers. Timely recognition and treatment of these symptoms may benefit quality of life, caregiver burden, and delay disease progression. In this qualitative study we examine the experiences of memory clinic physicians with the recognition and management of BPSD in early stages of AD.Methods:Semi-structured interviews were held with 8 physicians (5 neurologists, 3 geriatricians) employed at memory clinics of academic or general hospitals in the Netherlands. Two independent researchers coded verbatim transcripts of the interviews, followed by a consensus meeting on preliminary themes. In the upcoming months, additional interviews will be conducted until data saturation is reached.Results:Preliminary results indicate substantial variability in how memory clinic physicians recognize and diagnose BPSD in AD. Themes are: 1. Prevalence of BPSD in early stages of AD; e.g. ‘BPSD is more often present in late stages of AD […]’ vs. ‘I see this often, very often, I think these are the main problems people with AD face’). 2. Systematic assessment; some physicians consider it part of their clinical work-up to assess behavioral changes while other physicians do not touch upon BPSD. 3. Barriers for assessment; e.g. a lack of time, and not being able to observe BPSD occurring at home in a memory clinic setting. Treatment and management of BPSD in AD also differed greatly. Themes are 1. Treatment type; Two physicians discussed using a person-centered non-pharmacological approach, others refer patients with BPSD to daycare, a case manager or psychiatrist, or treat ‘problematic’ behaviors with psychotropic drugs. 2. Capabilities; some physicians experience managing BPSD in AD as very difficult, while others are confident about their capabilities. The majority suggests that collaboration with GPs or case managers may benefit treating these complex symptoms.Conclusion:There are remarkable differences in the recognition and management of BPSD in patients with AD visiting memory clinics in the Netherlands. Considering the potential benefit of early recognition and treatment, a first crucial step is discussing standardization of recognition and management of BPSD in memory clinics.
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Braun, Andreas, Daksha P. Trivedi, Angela Dickinson, Laura Hamilton, Claire Goodman, Heather Gage, Kunle Ashaye, Steve Iliffe, and Jill Manthorpe. "Managing behavioural and psychological symptoms in community dwelling older people with dementia: 2. A systematic review of qualitative studies." Dementia 18, no. 7-8 (March 20, 2018): 2950–70. http://dx.doi.org/10.1177/1471301218762856.
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Background People living with dementia often develop distressing behavioural and psychological symptoms (BPSD) that can affect their quality of life and the capacity of family carers and staff providing support at home. This systematic review of qualitative studies considers the views and experiences of people living with dementia and care providers about these symptoms and what helps to reduce their impact. Methods The two-stage review involved (a) An initial mapping of the literature to understand the range of BPSD, and how it is operationalised by different groups, to develop a search strategy; (b) A search of electronic databases from January 2000 to March 2015, updated in October 2016. Included studies focused on people living in their own homes. Data extraction and thematic analysis were structured to provide a narrative synthesis of the evidence. Results We retrieved 17, 871 records and included relevant qualitative papers (n = 58) targeting community-dwelling people with dementia and family carers around the management of BPSD. Five key themes were identified: (1) Helpful interventions/support for BPSD management, (2) Barriers to support services for BPSD management, (3) Challenges around recognition/diagnosis of BPSD, (4) Difficulties in responding to aggression and other BPSD, and (5) Impact of BPSD on family carers and people living with dementia. Conclusions Family carers sometimes feel that their experiences of BPSD may not be evident to professionals until a crisis point is reached. Some helpful services exist but access to support, lack of knowledge and skills, and limited information are consistently identified as barriers to their uptake. The lack of common terminology to identify and monitor the range of BPSD that people with dementia living at home may experience means that closer attention should be paid to family carer accounts. Future research should include qualitative studies to evaluate the relevance of interventions.
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Harris, Melissa L., Laura M. Struble, and Marita Titler. "ACUPUNCTURE AND ACUPRESSURE FOR DEMENTIA BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS: A SCOPING REVIEW." Innovation in Aging 3, Supplement_1 (November 2019): S116. http://dx.doi.org/10.1093/geroni/igz038.427.
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Abstract This scoping review synthesized the literature on acupuncture and acupressure therapy for treating behavioral and psychological symptoms of dementia (BPSD). BPSD affect most people with dementia and are overwhelming for caregivers and healthcare providers. Current evidence encourages use of nonpharmacologic interventions for BPSD due to the dangers of psychotropic medications. Acupuncture and acupressure present as alternative treatment options for BPSD. Systematic reviews examined acupuncture therapy for improving cognitive function, but not acupuncture and/or acupressure for BPSD. The methodology outlined by Joanna Briggs Institute Reviewers’ Manual guided this scoping review. Databases searched were PubMed, CINAHL, Embase, PsychINFO and AgeLine. Study inclusion criteria were published in English, subjects with dementia, acupuncture or acupressure tested and outcome measures included at least one BPSD. Gray literature was excluded. 836 citations were screened by title and abstract. 57 full texts were reviewed to determine inclusion criteria and 15 studies were retained. Nine studies examined acupressure and 6 examined acupuncture. Eight studies were RCT, 11 were conducted in China and 10 were conducted in long-term care. The percent of studies with statistically significant improvements in BPSD outcomes measured were: ADL’s (75%), agitation (100%), anxiety (67%), depression (100%), mood (100%), neuropsychological disturbances (67%) and sleep disturbances (100%). The therapies were safe and participant satisfaction was high across studies. Variations in research designs, outcome measures and incomplete descriptions of acupoints limit interpretations about effectiveness of these interventions for BPSD. Additional RCTs are needed to improve generalizability and to evaluate dosage/methods of acupressure and acupuncture for BPSD.
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Cheng, Ting-Wen, Ta-Fu Chen, Ping-Keung Yip, Mau-Sun Hua, Chi-Cheng Yang, and Ming-Jang Chiu. "Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients." International Psychogeriatrics 21, no. 6 (September 7, 2009): 1134–41. http://dx.doi.org/10.1017/s1041610209990767.
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ABSTRACTBackground: Behavioral and psychological symptoms of dementia (BPSD) cause caregiver distress and earlier institutionalization. We compared the prevalence and characteristics of BPSD between institution residents and memory clinic outpatients with Alzheimer's disease (AD) to test the hypothesis that there is more BPSD among institution residents than among their outpatient counterparts.Methods: We assessed BPSD by interviewing the patients’ principal caregivers, either family or professionals, using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Data from 138 patients with probable AD from the memory clinic and 173 residents with possible AD living in the long-term care facilities were collected. The diagnoses followed the NINCDS-ADRDA criteria.Results: BPSD profiles of the two groups were similar but not identical. The prevalence of at least one BPSD was high in both groups (community 81.9%, institution 74.9%). Activity disturbance was the most frequently reported BPSD in both groups (community 52.2%, institution 38.7%). Delusions, hallucinations, anxiety and aggressiveness were seen more frequently in memory clinic outpatients. The outpatients also had higher scores of BEHAVE-AD subscales in delusion/paranoid ideation, affective disturbance, and global rating of severity. With the increase of disease severity there were significantly more activity disturbance, psychosis, and aggressiveness in patients with AD.Conclusions: Caregiver factor and institution effect were two possible reasons for the higher prevalence and the greater severity of BPSD in community patients. BPSD caused more distress to family caregivers than the professional caregivers. High levels of psychotropic prescriptions for patients living in the long-term care facilities may also play a role.
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Vaingankar, Janhavi Ajit, Siow Ann Chong, Edimansyah Abdin, Louisa Picco, Anitha Jeyagurunathan, Esmond Seow, Li Ling Ng, Martin Prince, and Mythily Subramaniam. "Behavioral and psychological symptoms of dementia: prevalence, symptom groups and their correlates in community-based older adults with dementia in Singapore." International Psychogeriatrics 29, no. 8 (April 18, 2017): 1363–76. http://dx.doi.org/10.1017/s1041610217000564.
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ABSTRACTBackground:This study assessed the prevalence and factor structure of behavioral and psychological symptoms of dementia (BPSD) in a community-based sample of older adults with dementia and identified their correlates.Methods:Data collected from 399 Singapore residents with dementia aged 60 years and above, interviewed along with a family/friend during a national survey, were used for this analysis. Neuropsychiatric Inventory Questionnaire assessed older adults’ BPSD. Other data included socio-demographics, dementia severity, cognition, chronic physical conditions, disability, and caregivers’ burden. Exploratory factor analysis assessed BPSD sub-groups, factor scores of which were used to identify socio-demographic, and clinical correlates.Results:Prevalence of BPSD was 67.9% and 30% of the population had experienced three or more BPSD in the past month. Two distinct and moderately correlated symptom groups representing “psychosis and behavior dysregulation” and “mood disturbance and restlessness” were identified. As factor scores for both the groups increased with older age, poor cognition and caregiver burden, the former was also related to being never married and having no formal education.Conclusions:Study provides evidence of two distinct groups of BPSD and their important correlates. Clinicians treating BPSD should consider their age and cognitive impairment and be cognizant of their caregivers’ burden.
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Sampson, Elizabeth L., Nicola White, Baptiste Leurent, Sharon Scott, Kathryn Lord, Jeff Round, and Louise Jones. "Behavioural and psychiatric symptoms in people with dementia admitted to the acute hospital: prospective cohort study." British Journal of Psychiatry 205, no. 3 (September 2014): 189–96. http://dx.doi.org/10.1192/bjp.bp.113.130948.
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BackgroundDementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff.AimsTo define the prevalence of BPSD and explore their clinical associations.MethodLongitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (±1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality.ResultsParticipants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%).ConclusionsWe found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.
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Abengaña, Jennifer, Mei Sian Chong, and Laura Tay. "Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit." International Psychogeriatrics 29, no. 3 (December 5, 2016): 485–95. http://dx.doi.org/10.1017/s1041610216001836.
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ABSTRACTBackground: Overlap between neuropsychiatric symptoms of dementia and delirium complicates diagnosis of delirium superimposed on dementia (DSD). This study sought to examine differences in delirium presentation and outcomes between DSD patients with and without pre-existing behavioral and psychological symptoms of dementia (BPSD).Methods: This was a prospective cohort study of older adults with DSD admitted to a specialized delirium unit (December 2010–August 2012). We collected data on demographics, comorbidities, illness severity, delirium precipitants, and cognitive and functional scores. Delirium severity was assessed using Delirium Rating Scale Revised-98 (DRS-R-98) and Cognitive Assessment Method severity score (CAM-sev). Patients were categorized as DSD–BPSD+ and DSD–BPSD− based on elicited behavioral and psychological disturbances.Results: We recruited 174 patients with DSD (84.4 +/−7.4 years) with 37 (21.3%) having BPSD. At presentation, delirium severity and symptom frequency on DRS-R98 were similar, but DSD–BPSD+ more often required only a single precipitant (40.5% vs. 21.9%, p = 0.07), and had significantly longer delirium duration (median days: 7 vs. 5, p < 0.01). At delirium resolution, DSD–BPSD+ exhibited significant improvement in sleep–wake disturbances (89.2% vs. 54.1%, p < 0.01), affect lability (81.1% vs. 56.8%, p = 0.05), and motor agitation (73% vs. 40.5%, p < 0.01), while all non-cognitive symptoms except motor retardation were improved in DSD–BPSD−. Pharmacological restraint was more prevalent (62.2% vs. 40.1%, p = 0.03), and at higher doses (chlorpromazine equivalents 0.95 +/−1.8 vs. 0.40 +/−1.2, p < 0.01) in DSD–BPSD+.Conclusions: BPSD may increase vulnerability of dementia patients to delirium, with subsequent slower delirium recovery. Aggravation of sleep disturbance, labile affect, and motor agitation should raise suspicion for delirium among these patients.
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Hashimoto, Mamoru. "Treatment of BPSD." Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 47, no. 4 (2010): 294–97. http://dx.doi.org/10.3143/geriatrics.47.294.
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Kwon, Chan-Young, and Boram Lee. "Acupuncture for Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 10, no. 14 (July 13, 2021): 3087. http://dx.doi.org/10.3390/jcm10143087.
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Dementia is an important health issue worldwide, and non-pharmacological strategies for the management of behavioral and psychological symptoms of dementia (BPSD) are considered to be important. This review analyzes the effectiveness and safety of acupuncture for BPSD. Thirteen electronic databases were comprehensively searched to find clinical studies using acupuncture on BPSD, published up to December 2020. Five randomized controlled clinical trials and two before-after studies, mainly on Alzheimer’s disease (AD), were included. Meta-analysis suggested that the total effective rate based on BPSD symptoms in the acupuncture combined with psychotropic drugs group was significantly higher than that in the psychotropic drugs group (risk ratio, 1.27; 95% confidence interval, 1.11 to 1.45; I2 = 51%). In terms of other outcomes related to BPSD, acupuncture as an adjunctive therapy, but not as monotherapy, was associated with significant benefits in most included studies. However, the included studies did not have optimal methodological quality. Our review highlights the limited evidence proving the effectiveness and safety of acupuncture for BPSD in patients with AD. Although some clinical studies have reported the potential benefits of adjuvant acupuncture in managing BPSD, the evidence is not robust and is based on small studies. Therefore, high-quality research in this field is needed.
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Erkinjuntti, Timo, Risto Vataja, and Antero Leppävuori. "Behavioral and Psychological Symptoms of Dementia and Vascular Dementia." International Psychogeriatrics 12, S1 (July 2000): 195–200. http://dx.doi.org/10.1017/s104161020000702x.
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Behavioral and psychological symptoms of dementia (BPSD) have long been assumed to be an intrinsic clinical feature of vascular dementia. This assumption is based on case histories and selected series of patients with probable vascular dementia, especially those with small vessel disease, and has been further fueled by the inclusion of features of BPSD in clinical diagnostic algorithms (Cummings, 1994; Hachinski et al., 1975; Wallin et al., 1996). However, controlled empiric research on BPSD in vascular dementia is lacking. The existing literature does not fully support the assumption that BPSD are integral to vascular dementia.
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Eker, Engin, and Turan Ertan. "Behavioral and Psychological Symptoms of Dementia in Eastern and Southeastern Europe and the Middle East." International Psychogeriatrics 12, S1 (July 2000): 409–13. http://dx.doi.org/10.1017/s1041610200007365.
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Alzheimer's disease (AD) and associated behavioral and psychological symptoms of dementia (BPSD) are already recognized as major medical problems of the aging population in the western world. Although BPSD are not yet regarded as a major issue in many developing countries, such as Turkey, these symptoms will undoubtedly become a management issue in the future. Because BPSD contribute most to caregiver burden and interfere with patients' well being, they are predictors of early institutionalization (Hamel et al., 1990). This article reviews the literature on BPSD in eastern and southeastern Europe and the Middle East.
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Chiu, Edmond. "Vascular Burden and BPSD: A Reconceptualization." International Psychogeriatrics 15, S1 (July 2003): 183–86. http://dx.doi.org/10.1017/s1041610203009177.
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With increasing understanding of BPSD, the question of whether there are differences between BPSD of AD and VaD may be raised. The available evidence from the Cache County Study, the role of vascular risk factors in late-life depression, and vascular pathology in AD and VaD all converge to explore the impact of vascular burden on cerebral function and BPSD. This article argues that there may be domain differences in BPSD between AD and VaD and suggests that BPSVaD may be a concept to be pursued with possible useful clinical implications.
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Leung, Dara K. Y., Kayla K. Y. Wong, Aimee Spector, and Gloria H. Y. Wong. "Exploring dementia family carers’ self-initiated strategies in managing behavioural and psychological symptoms in dementia: a qualitative study." BMJ Open 11, no. 8 (August 2021): e048761. http://dx.doi.org/10.1136/bmjopen-2021-048761.
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ObjectivesCarer’s self-initiated management strategies of behavioural and psychological symptoms of dementia (BPSD) can inform intervention development. These strategies are affected by cultural values. Little is known about non-Western dementia carers’ BPSD management strategies. This study aimed to explore self-initiated strategies in managing BPSD adopted by Chinese carers.DesignQualitative study using thematic framework method.SettingCommunity setting in Hong Kong.Participants16 dementia carers with purposive sampling to include carers of different relationships to the people living with dementia (PLwD), education level and living arrangement.ResultsSix overarching themes emerged from the data: (1) maintaining personhood in PLwD, (2) responding positively to BPSD, (3) explanation and bargaining, (4) responding negatively to BPSD, (5) controlling upsetting thoughts, and (6) getting respite care. Chinese carers treasured warm and supportive family relationships. They identified and minimised triggers to alleviate BPSD. Some carers struggled with care tasks and reacted with confrontation and avoidance. Changing attitudes and getting social and emotional support were described to manage carers’ distress. Few self-care strategies including getting respite care were reported.ConclusionsCarers’ self-initiated strategies largely aligned with existing theoretical frameworks in BPSD management, such as person-centred approach, and echoed Asian culture, which advocates filial piety and supportive family relationships. While these cultural values encourage the engagement of people living with dementia in the normal process of family life, they may also prevent carers from taking time away from care. Interventions could support carers by enhancing their knowledge and skills in managing BPSD, providing social and emotional support, and providing guidance in self-care. Future cross-cultural research could explore factors contributing to how carers manage BPSD and how interventions could be culturally adapted to facilitate carers to apply learnt skills in daily practice and hence benefit the people living with dementia and carer population.
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Song, Jun-Ah, Myonghwa Park, Jaewon Park, Hong Jin Cheon, and Mihyun Lee. "Patient and Caregiver Interplay in Behavioral and Psychological Symptoms of Dementia: Family Caregiver’s Experience." Clinical Nursing Research 27, no. 1 (November 17, 2016): 12–34. http://dx.doi.org/10.1177/1054773816678979.
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The purpose of this study was to identify family caregivers’ experiences in managing the behavioral and psychological symptoms of dementia (BPSD) with particular focus on their interpersonal interactions with patient with dementia. Data were collected through focus-group interviews with 15 family caregivers from three local dementia-support centers located in Seoul. Data were analyzed using content analysis. Three main themes were identified through data analysis: triggers of BPSD, family caregiver’s actions in response to BPSD and patient’s reactions, and the effect of BPSD on family caregivers. Findings demonstrated that BPSD depended on the complex interplay of family caregivers and patients, including their interaction style. This information could help nurses when counseling and educating family caregivers to improve or modify their attitudes and approaches to behavioral symptoms of patients.
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Dawson, Walter, Sarah Gothard, Nora Mattek, Jeffrey Kaye, and Allison Lindauer. "WHAT DO 'BEHAVIORS" COST? UNDERSTANDING COSTS IN DEMENTIA CARE PARTNER-BASED RESEARCH." Innovation in Aging 6, Supplement_1 (November 1, 2022): 393–94. http://dx.doi.org/10.1093/geroni/igac059.1549.
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Abstract The out-of-pocket costs to care for individuals living with dementia are high, and is exacerbated by the expense of managing behavioral and psychological symptoms of dementia (BPSD) (e.g., depression, irritability). STELLA (Support via TEchnology: Living and Learning with Advancing AD) is a telehealth-based intervention that provides a personalized approach to teach care partners (CPs) strategies to manage BPSD. To understand the relationship between BPSDs and costs, weekly surveys were administered to CPs (n=12). Surveys asked about out-of-pocket costs incurred from: hospitalizations and emergency department (ED) utilization, primary care visits, use of paid in-home care, prescription drugs, and over-the-counter medications. The most frequent cost reported by CPs was prescription drug related (11 CPs), while costs associated with hospitalizations and ED were the least frequently reported (4 CPs). A longitudinal weekly survey-based approach to quantify CP costs is a novel approach examine an intervention outcome (cost) that matters to families and policymakers.
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Chang, Kuo-Hsuan, Chin-Chang Huang, Chiung-Mei Chen, Hsiu-Chuan Wu, and Hung-Chou Kuo. "Differences in Clinical Presentation of Behavioral and Psychological Symptoms of Dementia in Alzheimer’s Disease According to Sex and Education Level." Journal of Alzheimer's Disease 78, no. 2 (November 10, 2020): 711–19. http://dx.doi.org/10.3233/jad-200507.
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Background: The behavioral and psychological symptoms of dementia (BPSD) seriously affect the quality of life of patients with Alzheimer’s disease (AD) and their caregivers. Objective: We aimed to identify associations between demographic/genetic factors and clinical presentations of BPSD. Methods: In a cohort of 463 AD patients with BPSD, we retrospectively analyzed sex, education level, AD severity (assessed using the Clinical Dementia Rating and Mini-Mental Status Examination), and BPSD severity (assessed using the Neuropsychiatry Inventory, NPI). Severe BPSD was defined as NPI ≥10 for 3 consecutive years. Results: Among patients with severe BPSD (NPI ≥10), we observed more female patients (62.96%) and a lower level of education (6.03±4.77 years) as compared to those with mild BPSD (NPI <10) (female: 51.09%, p = 0.007; education years: 7.91±4.93, p < 0.001). Females had a lower level of education (5.72±4.50 years) and higher scores for depression/dysphoria (1.22±2.05) compared with males (education: 8.96±4.89 years, p < 0.001; depression/dysphoria: 0.78±1.42, p = 0.047). Patients with a high level of education (defined as ≥12 years) had higher scores for appetite/eating (0.90±2.02) than did those without (0.69±1.79; p = 0.001). Genetic analysis showed similar total and subscale NPI scores between patients with and without APOE4 and with and without the GRN rs5848 genotype. Conclusion: Our findings indicate potential contributions of sex and education to the presentation of BPSD. Further study is warranted to provide models for tailoring therapeutic programs to individual AD patients according to these factors.
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Resnick, Barbara, Marie Boltz, and Ann Kolanowski. "Findings From Implementation of the EIT-4-BPSD Trial." Innovation in Aging 5, Supplement_1 (December 1, 2021): 153. http://dx.doi.org/10.1093/geroni/igab046.588.
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Abstract Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home (NH) residents with dementia. BPSD result in negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medications and social isolation. Behavioral approaches are endorsed as the first line of treatment for BPSD. Despite regulatory requirements, less than 2% of nursing homes consistently implement these approaches. The EIT-4-BPSD Trial was done to test a novel implementation approach to assure that staff in nursing homes use non-pharmacologic, behavioral approaches for the management of BPSD. EIT-4-BPSD is a theoretically-based four-step approach that includes: 1. Assessment of the environment and policies; 2. Education of staff; 3. Establishing person-centered care plans; and 4. Mentoring and motivating staff. Implementation of the four-step approach was guided by the Evidence Integration Triangle (EIT). The EIT brings together evidence and key stakeholders from the NH and uses a participatory implementation processes, practical evidence-based interventions, and pragmatic measures of progress toward goals. A total of 55 nursing homes from two states and 553 residents were included in this study. Nursing homes were randomized to EIT-4-BPSD or education only. This symposium will describe the utility of the EIT as an implementation framework based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance model, report detailed effectiveness outcomes of EIT-4-BPSD at the setting and resident levels, and address recruitment and measurement challenges and future solutions to these challenges.
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Kagawa, Yoshiyuki, Yoshiaki Yamamoto, Ayami Ueno, Kengo Inomata, Mayu Tezuka, Takashi Osawa, Yasuharu Yazawa, Toshio Maeda, and Tomokazu Obi. "Impact of Plasma Donepezil Concentration on Behavioral and Psychological Symptoms of Dementia in Patients with Alzheimer’s Disease." Dementia and Geriatric Cognitive Disorders Extra 11, no. 3 (December 2, 2021): 264–72. http://dx.doi.org/10.1159/000516938.
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Background/Aims: The behavioral and psychological symptoms of dementia (BPSD) detract from the quality of life of not only dementia patients but also their family members and caregivers. Donepezil is used to treat Alzheimer’s disease and is metabolized via cytochrome P450 (CYP) 2D6 and CYP3A4/5. It is controversial whether donepezil improves or exacerbates BPSD. This study investigated the relationships among BPSD, the pharmacokinetics of donepezil including its metabolite, 6-O-desmethyl donepezil, genetic polymorphisms of CYPs and P-glycoprotein, and patient backgrounds in 52 patients with Alzheimer’s disease. Methods: BPSD were assessed using the Neuropsychiatric Inventory (NPI), with scores ≥20 points defined as severe BPSD. Plasma donepezil and 6-O-desmethyl donepezil concentrations were measured using liquid chromatography–tandem mass spectrometry. Results: Although significant relationships between NPI scores and plasma donepezil concentrations were not seen, none of the 15 patients (29%) with high plasma donepezil concentrations (≥60 ng/mL) developed severe BPSD. Polymorphisms of CYP2D6, CYP3A5, and ABCB1 did not influence NPI scores. There were no significant relationships between NPI and patient background factors such as dosing regimen, concomitant use of other drugs, or laboratory test results. Two patients who underwent multiple blood samplings over 2 years showed an inverse correlation between plasma donepezil concentrations and NPI scores. Discussion/Conclusions: These results indicate that higher plasma concentrations of donepezil contribute to preventing or alleviating rather than developing or deteriorating BPSD.
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Majic, T., J. P. Pluta, T. Mell, A. Decker, A. Heinz, and M. A. Rapp. "Prevalence of Behavioural and Psychological Symptoms of Dementia in Nursing Homes in Berlin." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70723-0.
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Background:Behavioral and Psychological Symptoms of Dementia (BPSD) include agitation, apathy, hallucinations, and depression. These symptoms are a challenge to professional nursing care, resulting in frequent psychiatric hospitalization, which incur high costs to the national healthcare systems.Objective:To estimate the prevalence of BPSD in nursing home residents in 16 representative nursing homes in Berlin, Germany.Methods:In a cross-sectional clustered cohort study, BPSD were assessed using the Dementia Mood Assessment Scale (DMAS), the Neuropsychiatric Inventary (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI). Dementia stage severity was measured by Functional Assessment Staging (FAST) and the Mini-Mnetals State Examination (MMSE). Furthermore, the patients" history recording psychotropics and number of psychiatric hospitalizations were registered. The prevalence and incidence rates of BPSD as well the duration of hospitalization and the quantity of drug prescription were estimated.Results:BPSD are common above all in nursing home residents with dementia, exhibiting prevalence rates of above 60% of all nursing home residents suffering from dementia. The severity of BPSD was related to number of psychiatric hospitalizations, the amount of psychotropics prescribed, and caregiver burden (p < .05).Conclusion:The high prevalence rate of BPSD reflects a significant problem in nursing home care, and is related to negative health outcomes and caregiver burden. Thus, nursing home care could be improved by minimizing the severity of BPSD, as well as the amount of drugs prescribed and the frequency of demented patients" hospitalization.
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Suh, Guk-Hee, and Seung Kyum Kim. "Behavioral and Psychological Signs and Symptoms of Dementia (BPSD) in antipsychotic-naïve Alzheimer's Disease patients." International Psychogeriatrics 16, no. 3 (September 2004): 337–50. http://dx.doi.org/10.1017/s1041610204000432.
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Background/Objective: There were few studies identifying the natural unfolding of behavioural and psychological symptoms of dementia (BPSD) in the course of Alzheimer's disease (AD) progression in antipsychotic-naïve AD patients. This study aims to examine the specific nature of the association between BPSD in AD and the global severity of illness measured by Global Deterioration Scale(GDS) in antipsychotic-naïve AD patients in Korea.Methods: A total of 562 antipsychotics-naïve AD patients were recruited from four different groups [a geriatric mental hospital (n=145), a semi-hospitalized dementia institution (n=120), a dementia clinic (n=114) and community-dwelling dementia patients (n=183)]. BPSD exhibited by AD patients were measured using the 25-item Korean version of the BEHAVE-AD.Results: Ninety-two percent (n=517) of AD patients had at least one BPSD, while 56% (n=315) had 4 or more BPSD. Specific kinds of behavioral disturbance peak at the stages of moderate AD (GDS stage 5) or moderately severe AD (GDS stage 6). AD patients left at home without any treatment had higher frequency of BPSD than did other groups seeking treatment, although all of them were antipsychotic-naïve.Conclusion: BPSD potentially remediable to treatment were highly frequent in Korean AD patients. Health policies to meet the unmet needs of elderly Koreans are urgently needed, especially for AD patients at home without treatment.
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Cohen-Mansfield, Jiska. "Use of Patient Characteristics to Determine Nonpharmacologic Interventions for Behavioral and Psychological Symptoms of Dementia." International Psychogeriatrics 12, S1 (July 2000): 373–80. http://dx.doi.org/10.1017/s1041610200007304.
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This article addresses the following questions about the use of patient characteristics to determine nonpharmacologic interventions for behavioral and psychological symptoms of dementia (BPSD): Why use patient characteristics to determine intervention?How does individualization of treatment fit with the theory of BPSD?What is known about individualization of the treatment of BPSD?How can individualization of nonpharmacologic intervention work in clinical practice?
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Thunell, Johanna, Geoffrey Joyce, Dima Qato, Jenny Guadamuz, and Julie Zissimopoulos. "Diagnosis of Behavioral Symptoms of Dementia and CNS-Active Drug Use Among Diverse Persons Living With Dementia." Innovation in Aging 5, Supplement_1 (December 1, 2021): 271. http://dx.doi.org/10.1093/geroni/igab046.1055.
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Abstract Approximately 90% of persons living with dementia (PLWD) experience behavioral and psychological symptoms of dementia (BPSD). Studies demonstrated high use of central nervous system (CNS) active drugs in nursing homes; one recent study documented high use among community-dwelling PLWD. Racial/ethnic disparities in BPSD diagnosis and CNS-active drug use, however, are unknown. We quantified disparities in BPSD diagnoses and CNS-active drug use using 100% Medicare Part A and B claims, 2017-2019, and Part D, 2018-2019. Beneficiaries were ages 65 and older in 2017, community-dwelling, and had a dementia diagnosis (n=801,597). We estimated models of CNS-active drug use to quantify racial/ethnic differences adjusting for confounders. Among PLWD, 66% had a BPSD diagnosis and 65% were taking a CNS-acting drug. Asians/Pacific Islanders were less likely to have a BPSD diagnosis (55%) than other groups, particularly affective diagnoses (40%). Whites were most likely to have any diagnosis (67%). Blacks were most likely to have hyperactivity diagnoses (7%). Antidepressants were most commonly used drug class (44%). Thirteen percent used an antipsychotic. Models adjusted for age, sex, comorbid conditions, dual-eligibility and BPSD diagnoses, showed non-Whites were less likely to use any CNS-active drug than Whites, but Blacks and Hispanics were slightly more likely to use antipsychotics. We found racial/ethnic differences in BPSD diagnoses and CNS-active drug use. Whether these disparities are due to differences in BPSD symptoms, health-care access or care-seeking remains an important question. Further study of disparity in outcomes associated with use will inform risk and benefit of CNS-active drugs use among PLWD.
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Ferreira, A. R., S. Martins, C. Dias, M. R. Simões, and L. Fernandes. "Behavioral and Psychological Symptoms: A Contribution for their Understanding Based on the Unmet Needs Model." European Psychiatry 41, S1 (April 2017): S657. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1105.
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IntroductionBehavioural and psychological symptoms (BPSD) are frequent in dementia and their contribution to poor health outcomes is well recognized. Four major frameworks attempt an explanation their aetiology: biological, behavioural, environmental vulnerability and unmet needs models. The latter states that BPSD are symptoms of needs that are not being met due to patients’ decreased ability to communicate/fulfil them. This model also implies that if needs were met, BPSD would improve.AimsTo explore the relation between needs and BPSD, and describe which unmet needs were contributing to BPSD in an elderly sample.MethodsA cross-sectional study was conducted in three Portuguese nursing homes. All residents were considered eligible. However, those unwilling or unable to participate were excluded. For each elderly patient, needs were assessed with camberwell assessment of need for the elderly/cane and BPSD with European Portuguese neuropsychiatric inventory/NPI.ResultsThe final sample included 166 elderly with an average of 80.9(sd = 10.2) years. Significant correlations between NPI and unmet and global needs were found (rs = 0.181,P = 0.020; rs = 0.254,P = 0.001, respectively). Additionally, the unmet needs of daytime activities (P = 0.019), company (P = 0.028) and behaviour (P = 0.001), presented significant correlations with NPI.ConclusionIn this sample, a high number of unmet needs were found. The absence of daytime activities, company and behaviour contributed to the identified BPSD, which is in line with other studies also highlighting the importance of these needs in nursing homes. This not only provides a framework for understanding BPSD, but also points to the identification of unmet needs as pivotal in prevention and treatment of these symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Kroustos, Kelly Reilly, Gretchen Horning, Jennifer Gurevich, Anna Gurevich, and Kristen Finley Sobota. "Remembering Your Roots: The Role of Horticulture Therapy in People Living with Dementia." Ohio Journal of Public Health 3, no. 1 (June 1, 2020): 40–44. http://dx.doi.org/10.18061/ojph.v3i1.9020.
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Introduction: Dementia is a debilitating disease affecting over 50 million people. Major challenges facing patients with dementia lie in the impact of the behavioral and psychological symptoms of dementia (BPSD). The American Geriatrics Society and Dementia Action Alliance recommend against the use of antipsychotics as first-line treatment. Antipsychotics often fail to treat BPSD whereas nonmedication practices such as horticulture therapy may lessen BPSD. Guideline evidence has provided a unique opportunity for public health officials to assist in filling this vital role in the approach to BPSD management.Methods: Several studies and meta-analyses were reviewed to determine the effectiveness of horticulture therapy in managing BPSD, and evidence supports horticulture therapy as an effective method of addressing BPSD.Results: The benefits of horticulture therapy extend beyond addressing only BPSD; through multisensory stimulation, patients have increased physical activity, reduced stress, and improved sleep. Horticulture therapy has been shown to decrease the sense of loss and reestablish the patient in a familiar nurturing role, providing the patient with a sense of purpose.Conclusion: Stakeholders within the public health sector are strategically positioned to implement evidence-based interventions that address the unmet needs for the care of dementia within the community.
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Anand, Abhinav, Puneet Khurana, Jasneet Chawla, Neha Sharma, and Navneet Khurana. "Emerging treatments for the behavioral and psychological symptoms of dementia." CNS Spectrums 23, no. 6 (September 15, 2017): 361–69. http://dx.doi.org/10.1017/s1092852917000530.
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Dementia is referred to a loss of memory and decline in other mental abilities at levels critical enough to hinder performance of daily activities. It can be of several types, depending on the underlying pathophysiology. The behavioral and psychological symptoms of dementia (BPSD) are various, but the most clinically significant are depression, apathy, and anxiety. Other BPSD include agitation, aberrant motor behavior, elation, hallucinations, and alterations in sleep and appetite. About 90% of sufferers of dementia are affected by BPSD during the course of the illness. These symptoms occur in demented patients irrespective of the dementia subtype. However, there has not been significant development in the areas of disease-modifying pharmacotherapeutics for dementia. Therefore, tackling BPSD has emerged as a research avenue in the recent past. Existing antidepressants, antipsychotics, and cholinergic agents have been extensively used in the treatment of BPSD, independently and in different combinations. However, these agents have not successful in completely alleviating such symptoms. Research in this field is going on globally, but it is still limited by various factors. There is a strong need to develop new entities and test them clinically. This review focuses on emerging treatments for the management of clinically significant BPSD.
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Haw, Camilla, Jean Stubbs, and Graeme Yorston. "Antipsychotics for BPSD: an audit of prescribing practice in a specialist psychiatric inpatient unit." International Psychogeriatrics 20, no. 4 (August 2008): 790–99. http://dx.doi.org/10.1017/s1041610208006819.
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ABSTRACTBackground: Antipsychotics are widely used for the treatment of behavioral and psychological symptoms of dementia (BPSD). In the light of the increased risk of cerebrovascular events, many countries have issued guidelines concerning their use in treating BPSD.Methods: We carried out an audit of antipsychotic prescribing practice for inpatients with BPSD at a tertiary referral centre using standards derived from two U.K. dementia guidelines. We collated case note and prescription data and interviewed consultant psychiatrists.Results: Of the 60 patients with dementia 50 (83%) had BPSD; of these, 28 (56%) were receiving antipsychotics. Those prescribed antipsychotics were more likely to have severe BPSD and to be aggressive and/or agitated. Audit of the 28 patients receiving antipsychotics for BPSD showed generally satisfactory results but there was room for improvement in case note documentation of off-label usage, screening for risk factors of cerebrovascular disease, consultation with relatives and use of an appropriate starting dose and slow titration of the antipsychotic.Conclusion: Audit of the use of antipsychotics for BPSD is important given the increased mortality associated with their use. Simple audit tools as used in this study can inform clinical practice. Even at a tertiary referral centre prescribing practice could be improved.
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Robert, Philippe H., Frans R. J. Verhey, E. Jane Byrne, Catherine Hurt, Peter Paul De Deyn, Flavio Nobili, Roberta Riello, et al. "Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium." European Psychiatry 20, no. 7 (November 2005): 490–96. http://dx.doi.org/10.1016/j.eurpsy.2004.09.031.
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AbstractBehavioral and psychological symptoms of dementia (BPSD), constitute a major clinical component of Alzheimer’s disease (AD). There is a growing interest in BPSD as they are responsible for a large share of the suffering of patients and caregivers, and they strongly determine the patient’s lifestyle and management. Better detection and understanding of these symptoms is essential to provide appropriate management. This article is a consensus produced by the behavioral group of the European Alzheimer’s Disease Consortium (EADC). The aim of this article is to present clinical description and biological correlates of the major behavioral and psychological symptomatology in AD. BPSD is not a unitary concept. Instead, it should be divided into several symptoms or more likely: groups of symptoms, each possibly reflecting a different prevalence, course over time, biological correlate and psychosocial determinants. There is some clinical evidence for clusters within groups of BPSD. Biological studies indicate that patients with AD and BPSD are associated with variations in the pathological features (atrophy, brain perfusion/metabolism, histopathology) when compared to people with AD without BPSD. An individually tailored approach taking all these aspects into account is warranted as it may offer more, and better, pharmacological and non-pharmacological treatment opportunities.
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Parker, Jennifer, Ryan Beazley, and Stephen De Souza. "Developing Inpatient Management Strategies for Behavioural and Psychological Symptoms of Dementia (DIMS-BPSD)." BJPsych Open 8, S1 (June 2022): S86—S87. http://dx.doi.org/10.1192/bjo.2022.278.
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AimsThis project details the development of a Quality Improvement Project aiming to review and improve the management of behavioural and psychological symptoms of dementia (BPSD) on an old age psychiatry ward. BPSD refers to a constellation of non-cognitive symptoms and signs which arise in people with dementia, including disturbed perception, thought content, mood or behaviour. Examples include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and socially inappropriate behaviours. BPSD arise in 5/6 of people with dementia over the course of their illness and are associated with a deterioration in cognition and progression in dementia plus secondary harms such as falls and hospitalisation. Pyrland Two ward is a mixed gender specialised organic old age psychiatry inpatient unit serving the county of Somerset. Most patients have a diagnosis of dementia, are being cared for using either MHA or MCA legislation and exhibit one or more BPSD. There was no structured or formalised approach to the management of BPSD at inception.Methods1.A point-in-time audit was conducted to produce baseline measurements of BPSD management on the ward, measured against NICE criteria.2.Plan-Do-Study-Act (PDSA) methodology was employed to incorporate incremental quality improvement interventions such as a ward-round checklist and staff education.Results•Baseline: (n = 14) 4/14 formally diagnosed with BPSD. 6/14 were prescribed antipsychotic medications, of which 1/6 fully met NICE standards. 2/14 had structured assessment tools used.•Results following introduction of improvement methods: (n = 8) 8/8 formally diagnosed with BPSD. 7/8 were prescribed antipsychotic medications, of which 4/7 fully met NICE standards. 7/8 had structured assessment tools used.ConclusionIt was possible to see modest improvements in the ward-based management of BPSD using quality improvement methodology, including more favourable psychotropic prescribing. However, total patient numbers are small and further interventions, such as more PDSA cycles, may add value and encourage sustainability.
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Cruz Da Fonseca, I., A. M. Romão Franco, R. Mendes, and A. Gamito. "Management of behavioral and psychological symptoms of dementia." European Psychiatry 64, S1 (April 2021): S424—S425. http://dx.doi.org/10.1192/j.eurpsy.2021.1132.
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IntroductionBehavioral and psychological symptoms of dementia (BPSD) are a heterogeneous group of clinical manifestations related to dementia, including apathy, depression, anxiety, delusions, hallucinations, disinhibition, sleep-wake cycle disturbances, aggression and agitation. BPSD have a negative impact on cognitive decline and increase complications.ObjectivesReview treatment management of BPSD including non-pharmacological and pharmacological options, but mainly interventional approaches, such as electroconvulsive therapy (ECT).MethodsWe conducted a search in PubMed and ClinicalKey with the terms: “Behavioral and psychological symptoms of dementia”; “Electroconvulsive therapy”.ResultsThe vast majority of patients with dementia will develop one or more BPSD. The etiopathogenesis of BPSD is complex and multifactorial, with multiple direct and indirect factors, namely biological, psychological and social aspects and related to changes in cholinergic, dopaminergic, noradrenergic and serotoninergic circuits. Current guidelines recommend non-pharmacological interventions as the first-line approach for BPSD. Pharmacotherapy is often applied, but it carries out the risk of serious side-effects and pharmacologic interactions. There is now growing evidence that interventional approaches, such as ECT, could be safe and efficient when previous treatment options have been exhausted or ineffective, with few contraindications and transient/limited adverse effects.ConclusionsBPSD represent a heterogeneous group of non-cognitive symptoms and behavior that affects most of dementia patients. Combination of non-pharmacological and pharmacological interventions is the recommended therapeutic for BPSD. However, there is usually limited clinical improvement and issues related to tolerability and effectiveness. Currently, ECT is considered a safe and effective option.