Psychological treatments (e.g. cognitive behavioural therapy (CBT), multisensory stimulation, relaxation, or animal-assisted therapies) should be considered for patients with mild-to-moderate dementia who have mild to moderate depression or anxiety; antidepressants should be reserved for pre-existing severe mental health problems.
What are behavioral and psychological symptoms of dementia?
While the presence of cognitive impairment is necessary and sufficient for a diagnosis of dementia, associated neuropsychiatric symptoms -known collectively as behavioral and psychological symptoms of dementia, or BPSD - are prevalent and can significantly impact the prognosis and management of dementia.
How do medications treat dementia symptoms?
Medication for managing dementia symptoms. Dementia causes mood swings and increased anxiety and agitation, so mood-stabilizing medications can be helpful for alleviating symptoms. A high percentage of dementia sufferers are afflicted by depression, so antidepressants are used to increase wellbeing and quality of life.
How is behavioral therapy used to treat dementia?
Behavioral therapy. Behavioral therapy is usually administered by qualified family or loved ones of dementia sufferers, or by the caregivers of afflicted individuals. This method is twice as effective as antipsychotics for treating symptoms like anxiety, aggression, depression, wandering, and insomnia.
What types of therapy are available for dementia patients?
Patients can choose from many different types of therapy, including therapies that align with their interests like music or art therapy. Also known as CST, cognitive stimulation therapy is clinically proven to help those with mild to moderate dementia and is the premiere therapy method for dementia patients.
What are the three treatments used for dementia symptoms?
The following are used to temporarily improve dementia symptoms.Cholinesterase inhibitors. These medications — including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne) — work by boosting levels of a chemical messenger involved in memory and judgment. ... Memantine. ... Other medications.
What type of therapy is used for dementia?
Cognitive behavioural therapy (CBT) They may have fewer difficulties with their memory, communication and reasoning. They are also usually more aware of their condition and their own thoughts and emotions than a person in the later stages of dementia. This will mean they can effectively engage with the therapy.
What therapy for persons with dementia reduces symptoms of agitation?
Researchers found that three nonpharmacologic interventions were more effective than usual care: multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy.
What are psychological interventions in dementia?
Abstract. Psychosocial interventions improve cognitive abilities (cognitive stimulation, cognitive training), enhance emotional well-being (activity planning, reminiscence), reduce behavioral symptoms (aromatherapy, music therapy) and promote everyday functioning (occupational therapy).
Is psychotherapy effective for dementia?
Ultimately, given space and time, supportive psychotherapy can help improve insight and self-understanding for people with dementia and their carers.
What do occupational therapists do for dementia?
An occupational therapist will work with someone with dementia to identify where there are difficulties in independent function and day-to-day activities. They'll recommend ways to adapt the environment to support the person with dementia, for example by adding dementia-friendly clocks or by labelling doors.
What is the best antipsychotic for dementia?
There are several antipsychotic drugs that may be used. Each one has slightly different effects on the brain and has its own potential risks and side effects. The drug with the most evidence to support its use in dementia is risperidone.
What is the best medication for agitation in dementia?
But common ones that can ease agitation include: Medicines that treat paranoia and confusion, called neuroleptics or antipsychotics. Examples of these are aripiprazole (Abilify), haloperidol (Haldol), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon).
What helps dementia patients with anxiety?
Reassure them that they're safe and that you're here to help. If they let you touch them, hold their hand, give them a hug, or give them a massage. Help them get gentle exercise, such as going for a walk or helping in the garden. If they had anxiety in the past, help them do things that helped before if possible.
Which of the following psychosocial interventions are effective in the management of dementia?
Aromatherapy and reminiscence therapy (RT) were the most effective psychosocial interventions for improving quality of life (QoL) in patients with moderate to severe dementia, according to results of a systemic review published in the International Journal of Geriatric Psychiatry.
What are examples of psychosocial interventions?
Psychosocial treatments (interventions) include structured counseling, motivational enhancement, case management, care-coordination, psychotherapy and relapse prevention.
What are the psychological interventions for Alzheimer's disease?
We included the following psychosocial interventions with usual care as the control: home-based exercise (HE), group exercise (GE), walking programs (WP), reminiscence therapy (RT), and art therapy (AT).
What is the best medication for dementia?
In psychotic, behaviorally disturbed elders, an ideal medication should have rapid onset, sustained action and minimal somatic and cognitive side effects (Daniel 2000). Conventional antipsychotics, such as haloperidol, have been used effectively to control the behavioral and psychological symptoms of dementia. Other drugs, such as valproate and carbamazepine, have shown some efficacy in controlling behavioral symptoms in elderly patients (Mellow et al 1993; Tariot et al 1994; DeVane and Mintzer 2003). However, only the atypical antipsychotics risperidone and olanzapine currently have the best evidence of efficacy in treating neuropsychiatric symptoms. Trials of cholinesterase inhibitors have had consistent yet small positive effects as well (Sink et al 2005).
How does aromatherapy help with dementia?
In a larger, double-blind, placebo-controlled trial, aromatherapy was found to be a safe and effective treatment for clinically significant agitation in patients with severe dementia (Ballard et al 2002). Lovell et al (1995)studied the effect of BLT on levels of agitation in moderately to severely demented persons. Agitation scores were significantly reduced during therapy compared with controls (Lovell et al 1995). Good sleep hygiene, avoidance of caffeine and alcohol, and adequate daytime physical activity can be beneficial, particularly for patients who have sleep disturbances and depression. In a randomized controlled trial by Teri et al (2003), a combination of exercise training and caregiver education on behavioral management techniques resulted in improvements in depression and a trend toward less institutionalization. Teaching caregivers techniques to minimize behavior problems can make the home environment less stressful for both the family and the patient (see Table 2). Sloane et al (2004)performed an RCT which measured agitation and aggression, comparing usual hygiene with person-centered showering and towel baths. Results showed that the latter techniques were effective methods of reducing BPSD during bathing persons with dementia. Finally, physical restraints should be avoided, for they are associated with injury, not protection, of confused or demented patients (Miles et al 1992; Sink et al 2005).
What are the symptoms of BPSD?
Drug-responsive symptoms include anxiety, verbal and physical agitation, hallucinations, delusions, and hostility, whereas wandering, hoarding, unsociability, poor self-care, screaming and other stereotypical behavior seem to be unresponsive to all drugs (Maletta 1990; Stoppe et al 1999). Pharmacologic intervention is often necessary and includes use of antidepressants for mood disorders, anticonvulsants for nonpsychotic agitation and antipsychotics for aggression, agitation and psychotic symptoms. Antidepressants, anxiolytics and hypnotics should only be used in patients with marked and persistent symptoms and drug treatment should be targeted to specific syndromes that are clinically significant because of their frequency, pervasiveness, or impact (Lawlor 2004).
What is BPSD in dementia?
More than 50% of people with dementia experience behavioral and psychological symptoms of dementia (BPSD). BPSD are distressing for patients and their caregivers, and are often the reason for placement into residential care. The development of BPSD is associated with a more rapid rate of cognitive decline, greater impairment in activities of daily living, and diminished quality of life (QOL). Evaluation of BPSD includes a thorough diagnostic investigation, consideration of the etiology of the dementia, and the exclusion of other causes, such as drug-induced delirium, pain, or infection. Care of patients with BPSD involves psychosocial treatments for both the patient and family. BPSD may respond to those environmental and psychosocial interventions, however, drug therapy is often required for more severe presentations. There are multiple classes of drugs used for BPSD, including antipsychotics, anticonvulsants, antidepressants, anxiolytics, cholinesterase inhibitors and NMDA modulators, but the evidence base for pharmacological management is poor, there is no clear standard of care, and treatment is often based on local pharmacotherapy customs. Clinicians should discuss the potential risks and benefits of treatment with patients and their surrogate decision makers, and must ensure a balance between side effects and tolerability compared with clinical benefit and QOL.
How many scales are there for dementia?
More than 30 scales are available for measuring the behavioral manifestations of dementia (Weiner et al 1996; Stoppe 1999). A number of instruments have been developed to assess the range and severity of BPSD (see Table 1). The most useful, in terms of outcomes assessment, are the Cohen-Mansfield Agitation Inventory (CMAI), neuropsychiatric inventory: nursing home version (NPI-NH), and behavioral pathology in AD (BEHAVE-AD) scales. They are particularly useful because of their specificity, reliability and validity in BPSD (Zaudig 2000; De Deyn et al 2001). It is not clear how much of a percentage change in each assessment tool represents a clinically significant response, however (Lee et al 2004).
What is the treatment for BPSD?
Care of patients with BPSD involves a broad range of psychosocial treatments for both the patient and family. Caregiver education, support and behavioral training are integral parts of the intervention for these patients (Lawlor 2004; Sink et al 2005). Interventions need to be approached in a systematic manner that includes management of the patient’s physical health, psychiatric symptoms, and environmental factors (Kozman et al 2006). In a study by Palmer et al (1999), the use of hearing aids improved scores on the BEHAVE-AD. Environmental adjustments, such as lifestyle support are generally first line interventions; however, many cases of aggression, agitation and psychotic symptoms may require pharmacotherapy (Zaudig 2000).
What percentage of long term care residents have dementia?
Eighty to 94% of residents of long term care facilities have a major psychiatric illness. Dementia is the most prevalent, observed in 47%–78% of residents (Rovner et al 1990; DeVane and Mintzer 2003). Regardless of its etiology, dementia is a clinical syndrome that expresses itself in three areas: cognitive deficits, psychiatric and behavioral disturbances, and difficulties in carrying out daily functions (De Dyn et al 2005). Alois Alzheimer, in his 1906 description of dementia, noted behavioral and psychological symptoms of dementia (BPSD) are prominent manifestations of the illness, including paranoia, delusions of sexual abuse, hallucinations and screaming (Kozman et al 2006). In 1996, the International Psychogeriatric Association convened a consensus conference on the behavioral disturbances in dementia. The consensus group made this statement: “The term behavioral disturbances should be replaced by the term BPSD, defined as symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia (Kozman et al 2006, p 1).” BPSD is not a diagnostic entity but is instead a term that describes a clinical dimension of dementia (Lawlor 2004). The multiple cognitive impairments of dementia are often associated with mood disorders and sleep disturbances. BPSD includes disinhibited behavior, delusions and hallucinations, verbal and physical aggression, agitation, anxiety and depression (Carson et al 2006). BPSD can cause tremendous distress for both the patient and the caregiver, and is often the trigger for referral of these patients to primary care and specialist services and placement in residential or nursing home care (Steele et al 1990; Ballard et al 2006). The development of BPSD is also associated with a poorer prognosis, a more rapid rate of cognitive decline, illness progression (Stern et al 1987; Paulsen et al 2000), greater impairment in activities of daily living (ADLs) (Lyketsos et al 1997) and diminished quality of life (QOL) (Gonzales-Salvador et al 2000), and it adds significantly to the direct and indirect costs of care (O’Brien and Caro 2001).
How does therapy help dementia?
Research has shown that therapy improves well being, day-to-day functioning, and overall mood in dementia sufferers. Dementia is correlated with increased anxiety and depression, so professional counseling and a strong support system are integral to maintaining and improving overall well being. Patients can choose from many different types of therapy, including therapies that align with their interests like music or art therapy.
How to manage dementia?
Dementia hugely affects everyday functioning both for sufferers and for their loved ones, and coping with dementia can require major lifestyle and environmental changes. A comprehensive management system includes therapy and counseling to manage possible stress, anxiety, and depression.
What is the best medication for dementia?
There are several classes of medications proven to work at treating symptoms and reducing the effects of dementia, which include: Cholinesterase inhibitors: Aricept (donepezil), Razadyne (galantamine) and Exelon (rivastigmine).
How does reality orientation therapy help dementia patients?
Reality Orientation Therapy, which works to reduce confusion and disorientation that accompanies dementia by providing orienting information about time and location several times throughout the day.
Why are antidepressants used for dementia?
A high percentage of dementia sufferers are afflicted by depression, so antidepressants are used to increase wellbeing and quality of life.
What is the effect of cholinesterase inhibitors on Alzheimer's?
Cholinesterase inhibitors alleviate symptoms of Lewy-body dementia and Alzheimer's disease by slowing the breakdown of Acetylcholinesterase, which plays a role in learning, memory, and cognitive skills.
What are the side effects of dementia medication?
Side effects of medications used to alleviate dementia symptoms include nausea, dizziness, vomiting, slowed heart rate and diarrhea. A doctor or healthcare professional can prescribe the medication that best fits an individual's condition and situation.
How many people will die from Alzheimer's in 2050?
In 2010 there were 35.6 million individuals living with dementia and their numbers are expected to double every 20 years and reach approximately 115.4 million by 2050. 1
What is BPSD assessment?
An assessment of BPSD includes the use of standardized and validated assessment scales such as the Neuropsychiatry Inventory (NPI) or the Behavioral Pathology in Alzheimer Disease Rating Scale (BEHAVE-AD). These standardized tools can assist in qualifying and quantifying the BPSD. They can also assist with tracking the progression of BPSD and the efficacy of interventions.
What is BPSD in medical terms?
Behavioral and psychological symptoms of dementia (BPSD) is used to describe a group of diverse non-cognitive symptoms and behaviors that are frequently seen among individuals with dementia. BPSD affects approximately 90% of individuals at some point during the course of the illness, with greater prevalence noted among individuals receiving skilled care. 2
What is BPSD in psychology?
Behavioral and psychological symptoms of dementia (BPSD) is used to describe a group of diverse non-cognitive symptoms and behaviors that are frequently seen among individuals with dementia. BPSD affects approximately 90% of individuals at some point during the course of the illness, with greater prevalence noted among individuals receiving skilled ...
What is nonpharmacological intervention?
6 Nonpharmacological interventions that targets both the patient and the provider improves the lives of both partners in the dyad.
What are the symptoms of BPSD?
Common BPSD include apathy, anxiety, depression, agitation, psychosis, sleep disturbances, dysphoria, aberrant motor activity, hallucinations and delusions. There is emerging evidence that specific symptom patterns can be identified in different types of dementias. One recent study found that hallucination, abnormal motor behavior, and anxiety were significantly more frequent in Alzheimer disease (AD) and mixed dementia (MD) compared with vascular dementia (VD). 3 Hallucinations and delusions were significantly more severe in AD and MD . Disinhibition was significantly more frequent and severe and agitation was significantly more severe in patients with VD.
What is the purpose of a thorough medication review?
A thorough medication review will help eliminate the effect of medications, which may cause and/or aggravate the BPSD. This is also true of any illicit substances.
What are the symptoms of BPSD?
The most common BPSD symptoms experience include depression and apathy, although delusions, agitation, and aberrant motor behaviors (like fidgeting, repetitive behaviors, wandering) happen in about one-third of patients. These symptoms can be very frustrating and challenging for both patients and their caregivers. 1.
What is BPSD?
This brain deterioration frequently causes personality, behavioral, psychological, and emotional changes, which can be referred to as BPSD.
Is antipsychotic medication good for paranoia?
For example, if someone is experiencing distressing hallucinations, delusions, or paranoia, an antipsychotic medication might be appropriate to relieve the distress. However, these medications do have the potential for significant side effects, so careful monitoring is a must.
Is non-drug therapy effective?
It depends. In many cases, non-drug approaches are the safest and most effective way to manage these symptoms. Strategies such as attempting to determine the cause of the behavior and meet or prevent that need can be very effective at times.
Does the Mind diet help with Alzheimer's?
When it comes to Alzheimer's, the MIND diet has shown promise in reducing risk and promoting brain health. Sign up for our Alzheimer’s and Dementia Newsletter and get your free recipe guide today.
What are the risk factors for Alzheimer's?
Bennett’s study, along with a number of subsequent investigations, established that neuroticism, depression, social isolation, and other social traits are all risk factors for Alzheimer’s and other forms of dementia.
Where does cortisol affect memory?
We may be able to use this knowledge to develop a drug that blocks the effects of the stress hormone cortisol on the hippocampal region of the brain, where memory and learning happen. Researchers have already identified molecules that can block the cortisol receptor and mitigate the negative effect of cortisol on the brain.
Is cynicism a sign of dementia?
Are cynical people more likely to develop dementia? According to a new study in Neurology, the answer is “yes.” The study, said to be the first to exclusively examine the link between cynicism and dementia, adds to a growing body of evidence on the psychological risk factors for Alzheimer’s and other dementias.
Does Alzheimer's disease have a drug discovery foundation?
The Alzheimer’s Drug Discovery Foundation has funded a number of studies investigating such stress blocking compounds and plans to support their continued development. Drugs used to treat depression may also hold promise for Alzheimer’s patients .
Is dementia a psychological risk factor?
Many of the negative psychological risk factors linked to dementia are associated with stress—or, more precisely, distress. While stress is always in our environment, distress only occurs when we have a negative psychological response to stress.