scholarly journals Evidence-Based Pharmacological Management and Treatment of Behavioral and Psychological Symptoms of Dementia

2019 ◽  
Vol 14 (6) ◽  
pp. 3-5 ◽  
Author(s):  
Juan Joseph Young
Keyword(s):  
Psychological Symptoms ◽  
Evidence Based ◽  
Pharmacological Management ◽  
Behavioral And Psychological Symptoms

scholarly journals Pharmacologic management of behavioral and psychological symptoms of major neurocognitive disorder

2018 ◽  
Vol 8 (6) ◽  
pp. 284-293 ◽  
Author(s):  
Monica Mathys
Keyword(s):  
Psychological Symptoms ◽  
Psychotropic Medications ◽  
Evidence Based ◽  
Neurocognitive Disorder ◽  
Medication Regimen ◽  
First Line ◽  
Risks And Benefits ◽  
Pharmacologic Management ◽  
Behavioral And Psychological Symptoms ◽  
First Line Treatment

Abstract Behavioral and psychological symptoms of dementia (BPSD) occur in approximately 80% of patients who receive a diagnosis of major neurocognitive disorder. Nonpharmacologic strategies are the first-line treatment for BPSD. However, psychotropic medications are often necessary when nonpharmacologic methods are not effective in treating symptoms that are distressing or are causing behaviors that are dangerous to the patient or the patient's caregivers. The article provides a review of evidence-based recommendations for the use of antipsychotics, cognitive enhancers, and serotonin reuptake inhibitors for the treatment of BPSD. Different pharmacologic approaches are demonstrated through 2 patient cases in which nonpharmacologic management was not effective. The severity of BPSD must be weighed against the risks and benefits of pharmacologic intervention in order to implement an optimal medication regimen.

scholarly journals Effectiveness of the Care of Persons With Dementia in Their Environments Intervention When Embedded in a Publicly Funded Home- and Community-Based Service Program

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Richard H Fortinsky ◽  
Laura N Gitlin ◽  
Laura T Pizzi ◽  
Catherine Verrier Piersol ◽  
James Grady ◽  
...  
Keyword(s):  
Psychological Symptoms ◽  
Pragmatic Trial ◽  
Well Being ◽  
Functional Independence ◽  
Evidence Based ◽  
Publicly Funded ◽  
Long Term Effects ◽  
Community Based ◽  
Activity Engagement ◽  
Behavioral And Psychological Symptoms

Abstract Background and Objectives In the absence of effective pharmacotherapy, there is an urgent need to test evidence-based dementia care interventions using pragmatic trial approaches. We present results from a study in which an evidence-based, nonpharmacologic intervention for persons living with Alzheimer’s disease and related dementia (ADRD) and their informal caregivers, Care of Persons with Dementia in their Environments (COPE), was tested in a Medicaid and state revenue-funded home and community-based service (HCBS) program. Research Design and Methods Using pragmatic trial design strategies, persons living with ADRD and their caregivers were randomly assigned as dyads to receive COPE plus usual HCBS (COPE; n = 145 dyads) or usual HCBS only (Usual Care or UC; n = 146 dyads). Outcomes were measured prerandomization, and 4 and 12 months postrandomization. Outcomes for persons living with ADRD included functional independence, activity engagement, self-reported quality of life, and behavioral and psychological symptoms. Caregiver outcomes included perceived well-being, confidence using dementia management strategies, and degree of distress caused by behavioral and psychological symptoms. Results After 4 months, caregivers receiving COPE reported greater perceived well-being (least squares mean = 3.2; 95% CI: 3.1–3.3) than caregivers receiving UC (3.0; 2.9–3.0; p < .001), and persons living with ADRD receiving COPE, compared to those receiving UC, showed a strong trend toward experiencing less frequent and less severe behavioral and psychological symptoms (9.7; 5.2–14.2 vs 12.7; 8.3–17.1; p = .07). After 12 months, persons living with ADRD receiving COPE were more engaged in meaningful activities (2.1; 2.0–2.1 vs 1.9; 1.9–2.0; p = .02) than those receiving UC. Discussion and Implications Embedding COPE in a publicly funded HCBS program yielded positive immediate effects on caregivers’ well-being, marginal positive immediate effects on behavioral and psychological symptoms, and long-term effects on meaningful activity engagement among persons living with ADRD. Findings suggest that COPE can be effectively integrated into this service system, an important step towards widespread adoption. Clinical Trials Registration Number NCT02365051.

Implementation of evidence-based, non-pharmacological interventions addressing behavior and psychological symptoms of dementia: a systematic review focused on implementation strategies

2020 ◽  
pp. 1-29
Author(s):  
Sally Bennett ◽  
Kate Laver ◽  
Margaret MacAndrew ◽  
Elizabeth Beattie ◽  
Lindy Clemson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quantitative Methods ◽  
Psychological Symptoms ◽  
Implementation Strategies ◽  
Practice Change ◽  
Evidence Based ◽  
Pharmacological Interventions ◽  
People With Dementia ◽  
Implementation Studies ◽  
Behavioral And Psychological Symptoms

ABSTRACT Objective This study aimed to identify the nature and effects of implementation strategies to increase the use of evidence-based, non-pharmacological interventions designed to reduce the frequency and/or severity of behavioral and psychological symptoms associated with dementia, for people living in the community. Design This was a systematic review of implementation studies. We searched six databases (in January 2019) and hand-searched reference lists of reports. Studies were included if they used quantitative methods evaluating the use of implementation strategies to increase the use of non-pharmacological interventions. These interventions had to have been tested in a randomized controlled trial (RCT) and found to reduce behavioral and psychological symptoms of dementia, for those living in the community. Studies needed to report the effect of the implementation on clinical practice, for example, a change in practice or the adoption of the intervention in community settings. Results Twelve studies were included: 11 one-group pre-post design studies and 1 cluster RCT. All studies reported practice change – the majority implementing a new intervention, with six different types of interventions implemented. All studies reported including using partnerships, new funding, educational strategies, and ongoing support and consultation. Seven implementation studies reported positive outcomes for clients on some aspect of behavior or depression for the person with dementia. Conclusions Implementation studies using multiple implementation strategies to increase the use of non-pharmacological interventions have demonstrated improvements in behavioral and psychological symptoms common in people with dementia, when provided by clinicians as part of their everyday work routines.

scholarly journals Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia

2018 ◽  
Vol 58 (suppl_1) ◽  
pp. S88-S102 ◽  
Author(s):  
Kezia Scales ◽  
Sheryl Zimmerman ◽  
Stephanie J Miller
Keyword(s):  
Psychological Symptoms ◽  
Evidence Based ◽  
Behavioral And Psychological Symptoms

How do family carers respond to behavioral and psychological symptoms of dementia?

2013 ◽  
Vol 25 (5) ◽  
pp. 743-753 ◽  
Author(s):  
Kirsten Moore ◽  
Elizabeth Ozanne ◽  
David Ames ◽  
Briony Dow
Keyword(s):  
Unmet Needs ◽  
Psychological Symptoms ◽  
Functional Decline ◽  
Structured Interview ◽  
Aged Care ◽  
Evidence Based ◽  
Family Carers ◽  
Neuropsychiatric Inventory ◽  
Evidence Based Programs ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground: Behavioral and psychological symptoms of dementia (BPSD) have been associated with increased carer burden and early institutionalization. BPSD are more responsive to treatment than are cognitive and functional decline. Little is known about how family carers understand and try to reduce these symptoms. This study aimed to explore the strategies used by carers looking after someone with high levels of BPSD.Methods: Twenty-five carers were interviewed using a semi-structured interview with the Neuropsychiatric Inventory (NPI). They were all caring for someone eligible for an Extended Aged Care at Home Dementia Package, which targets people with BPSD.Results: Participants reported high levels of BPSD with a mean score of 8.2 for symptoms (range 2–12, SD = 2.38) and a mean NPI score of 51.4 (range 14–111, SD = 28.74). Distress scores were also high with a mean of 18.5 (range 2–42, SD = 11.33). Carers described on average, fewer than four strategies for managing BPSD. Encouraging activity, utilizing psychotropic medications, identifying triggers, restraining or treating in a paternalistic manner, and meeting physiological needs were the most commonly used strategies.Conclusion: While family carers are often at the forefront of identifying triggers and addressing unmet needs, findings from this study suggest that some carers have a limited repertoire of strategies despite experiencing a large number of symptoms. There is a clear need for ensuring evidence-based programs to educate and support carers in identifying triggers, understanding symptoms and learning to cope with these symptoms.

A survey of Australian and New Zealand old age psychiatrists' preferred medications to treat behavioral and psychological symptoms of dementia (BPSD)

2005 ◽  
Vol 17 (2) ◽  
pp. 195-205 ◽  
Author(s):  
Melissa Greve ◽  
Daniel O'Connor
Keyword(s):  
New Zealand ◽  
Old Age ◽  
Cholinesterase Inhibitors ◽  
Psychological Symptoms ◽  
Atypical Neuroleptics ◽  
Drug Trials ◽  
Pharmacological Management ◽  
Scientific Support ◽  
Behavioral And Psychological Symptoms

Background: People with behavioral and psychological symptoms of dementia (BPSD) are often prescribed psychotropic medications. There is little evidence that one class of medication is more effective and safer than another and so expert opinion plays an important role in shaping local practice. In an earlier U.S. survey of psychiatrists and neurologists, limited consensus emerged regarding the pharmacological management of BPSD. We repeated this study to check consensus levels in Australia and New Zealand, following the introduction of newer atypical neuroleptics, antidepressants and cholinesterase inhibitors, and to identify areas where drug trials will be of greatest benefit.Methods: A brief structured survey, similar to one used in the U.S.A., was posted to a random sample of members of the Australian and New Zealand Faculty of Psychiatry of Old Age.Results: We received 106 replies (71% response). Respondents, who had 14 years' experience on average, rated atypical neuroleptics as their treatment of choice for dementia complicated by psychosis, verbal aggression, physical aggression, sundowning and persistent yelling. Opinions varied widely regarding the management of other symptoms and the role of second-line treatments.Conclusion: Atypical neuroleptics were preferred by most respondents for treatment of most BPSD. These views, while based on considerable clinical experience, have only limited backing from published reports, and head-to-head studies of available treatments are required to ensure that clinical practice has scientific support.

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