scholarly journals Antipsychotic prescribing for behavioural and psychological symptoms of dementia

2007 ◽  
Vol 31 (5) ◽  
pp. 176-178 ◽  
Author(s):  
Ayodeji Soyinka ◽  
David Lawley
Keyword(s):  
Old Age ◽  
Antipsychotic Drugs ◽  
Psychological Symptoms ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Audit Cycle ◽  
Two Phases ◽  
Evidence Based Guidelines ◽  
Discharge Summaries

Aims and MethodTo review the quality of information and advice contained in correspondence from old age psychiatrists to general practitioners (GPs) regarding the prescription of antipsychotic drugs for the management of behavioural and psychological symptoms of dementia. Discharge summaries (n=22) and subsequent out-patient review letters were examined and compared with evidence-based guidelines in two phases of an audit cycle; first in 2002 and latterly in 2005.ResultsPractice was below acceptable standards during both phases of the audit cycle, with an actual drop in the quality of explicit advice given to GPs in 2005, despite national publicity about the issues and guidance from the Royal College of Psychiatrists.Clinical ImplicationsThe prescription of antipsychotic drugs is associated with an adverse prognosis for people with dementia. As such, it is imperative that such treatment is regularly reviewed and time limited. Old age psychiatrists need to ensure that this message is communicated to their primary care colleagues.

Behavioural and psychological symptoms of dementia

2020 ◽  
pp. 247-258
Author(s):  
Rianne van der Linde ◽  
Tom Dening
Keyword(s):  
Quality Of Life ◽  
Environmental Factors ◽  
Psychological Symptoms ◽  
Symptom Clusters ◽  
Psychotic Symptoms ◽  
Mixed Group ◽  
People With Dementia ◽  
Affective Symptoms ◽  
Behavioural And Psychological Symptoms

The term: ‘behavioural and psychological symptoms of dementia’ (BPSD) refers to a mixed group of phenomena. BPSD are the non-cognitive features of dementia and include depression, anxiety, psychotic symptoms, apathy, irritability, aggression, and sleep and eating problems. They occur in around 80% of people with dementia at some stage, several of them becoming more frequent as dementia progresses. Some BPSD, notably apathy, are very persistent. BPSD often limit the person’s quality of life and can be stressful for carers. Causes of BPSD include biological, psychological, social, and environmental factors. This chapter explores how they are assessed and measured, and how they may usefully grouped together in symptom clusters. Usually four symptom groups are found: affective symptoms, psychosis, hyperactivity, and euphoria. However, these are not always consistent and in particular apathy does not consistently belong in one group. Approaches to management of BPSD are outlined.

scholarly journals Use of parametric speaker for older people with dementia in a residential care setting: A preliminary study of two cases

2018 ◽  
Vol 31 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Yuko Nishiura ◽  
Minoru Hoshiyama ◽  
Yoko Konagaya
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Psychological Symptoms ◽  
Personal Space ◽  
Acoustic Environment ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Technological Intervention ◽  
Narrow Space

Objective/Background Older people with dementia often show behavioural and psychological symptoms of dementia such as agitation, aggression, and depression that affect their activities of daily living, and hence reduce the quality of life of their caregivers. The aim of this study was to investigate the effects of a new technological intervention—a parametric speaker, creating a narrow personal acoustic environment, which may reduce the manifestation of behavioural and psychological symptoms of dementia symptoms. Methods A parametric speaker was placed on the ceiling of a large day room, and personally selected pieces of music were provided in a narrow space just under the speaker during the intervention. Two older residents with behavioural and psychological symptoms of dementia participated in the experiment. Results Playing pieces of favorite music via the parametric speaker decreased their behavioural and psychological symptoms of dementia during the intervention. In addition, this intervention reduced the burden on caregivers. One of the advantages of using parametric speaker was being able to create a personal space in a common room. Conclusion We considered that the parametric speaker might be useful to reduce behavioural and psychological symptoms of dementia and the burden on caregivers, providing individualized rehabilitation for the improved quality of life of residents.

scholarly journals Ethical dilemmas: should antipsychotics ever be prescribed for people with dementia?

2010 ◽  
Vol 197 (2) ◽  
pp. 88-90 ◽  
Author(s):  
Adrian Treloar ◽  
Monica Crugel ◽  
Aparna Prasanna ◽  
Luke Solomons ◽  
Chris Fox ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Psychological Symptoms ◽  
Ethical Dilemmas ◽  
Evidence Based ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Evidence Based Guidelines

SummaryThe use of antipsychotics for the treatment of behavioural and psychological symptoms of dementia (BPSD) is controversial. Antipsychotics cause harm and evidence-based guidelines advise against their use. We argue that antipsychotics may be justified using a palliative model: by reducing severe distress in those whose life expectancy is short.

scholarly journals Degree of personalisation in tailored activities and its effect on behavioural and psychological symptoms and quality of life among people with dementia: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e048917
Author(s):  
Shiyu Lu ◽  
Anna Y Zhang ◽  
Tianyin Liu ◽  
Jacky C P Choy ◽  
Maggie S L Ma ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Moderate Effect ◽  
Mean Differences ◽  
High Level

ObjectivesTo understand and assess the degree of personalisation of tailored activities for people with dementia (PWD); and to estimate the magnitude of the effects of levels of personalisation on reducing behavioural and psychological symptoms of dementia (BPSD), improving quality of life (QoL) and level of engagement.DesignSystematic review with meta-analysis.Data sourcesProQuest, PubMed, Ovid, Cochrane Library, Web of Science and CINAHL were searched from the start of indexing to May 2020.Eligibility criteriaWe included randomised controlled trials and quasi-experimental studies assessing the effects of tailored activities for people aged 60 years or older with dementia or cognitive impairment on the outcomes of BPSD, QoL, depression and level of engagement with control groups.Data extraction and synthesisTwo researchers screened studies, extracted data and assessed risks of bias. A rating scheme to assess the degree of personalisation of tailored activities was developed to classify tailored activities into high/medium/low groups. Effect sizes were expressed using standardised mean differences at 95% Confidence Interval (CI). Subgroup analyses were conducted to assess whether the degree of personalisation of tailored activities affected outcomes of interest.ResultsThirty-five studies covering 2390 participants from 16 countries/regions were identified. Studies with a high-level of personalisation interventions (n=8) had a significant and moderate effect on reducing BPSD (standardised mean differences, SMD=−0.52, p<0.05), followed by medium (n=6; SMD=−0.38, p=0.071) and low-level personalisation interventions (n=6; SMD=−0.15, p=0.076). Tailored activities with a high-level of personalisation had a moderate effect size on improving QoL (n=5; SMD=0.52, p<0.05), followed by a medium level (n=3; SMD=0.41, p<0.05) of personalisation.ConclusionsTo develop high-level tailored activities to reduce BPSD and improve QoL among PWD, we recommend applying comprehensive assessments to identify and address two or more PWD characteristics in designed tailored activities and allow modification of interventions to respond to changing PWD needs/circumstances.PROSPERO registration numberCRD42020168556.

The effect and importance of physical activity on behavioural and psychological symptoms in people with dementia: A systematic mixed studies review

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 533-546 ◽  
Author(s):  
Tina Junge ◽  
Jonas Ahler ◽  
Hans K Knudsen ◽  
Hanne K Kristensen
Keyword(s):  
Physical Activity ◽  
Psychological Symptoms ◽  
Qualitative Studies ◽  
Quantitative Studies ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Mixed Studies Review ◽  
Depression Level ◽  
Systematic Mixed Studies Review

Background People with dementia may benefit from the effect of physical activity on behavioural and psychological symptoms of dementia. Qualitative synthesis of the importance of physical activity might complement and help clarify quantitative findings on this topic. The purpose of this systematic mixed studies review was to evaluate findings from both quantitative and qualitative methods about the effect and importance of physical activity on behavioural and psychological symptoms of dementia in people with dementia. Methods The systematic literature search was conducted in EMBASE, CINAHL, PubMed, PEDro and PsycINFO. Inclusion criteria were: people with a light to moderate degree of dementia, interventions including physical activity and outcomes focusing on behavioural and psychological symptoms of dementia or quality of life. To assess the methodological quality of the studies, the AMSTAR and GRADE checklists were applied for the quantitative studies and the CASP qualitative checklist for the qualitative studies. Results A small reduction in depression level and improved mood were seen in some quantitative studies of multi-component physical activity interventions, including walking. Due to high heterogeneity in the quantitative studies, a single summary of the effect of physical activity on behavioural and psychological symptoms of dementia should be interpreted with some caution. Across the qualitative studies, the common themes about the importance of physical activity were its ‘socially rewarding’ nature, the ‘benefits of walking outdoors’ and its contribution to ‘maintaining self-hood’. Conclusion For people with dementia, there was a small, quantitative effect of multi-component physical activity including walking, on depression level and mood. People with dementia reported the importance of walking outdoors, experiencing the social rewards of physical activity in groups, as well as physical activity were a means toward maintaining self-hood.

scholarly journals Training needs on behavioural and psychological symptoms of dementia for professional caregivers in residential homes: a qualitative study

2020 ◽  
Vol 10 ◽  
pp. 384-393
Author(s):  
Carolina Pinazo
Keyword(s):  
Qualitative Study ◽  
Psychological Symptoms ◽  
The Elderly ◽  
Training Needs ◽  
Residential Setting ◽  
Residential Homes ◽  
Ongoing Training ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Low Levels

The behavioural and psychological symptoms of dementia are very predominant in the disease, aggravating the suffering of people with dementia and increasing the physical and emotional burden professional caregivers are exposed to. Despite being so present in nursing homes, professional caregivers do not always have adequate training or the tools needed to deal with these situations. Objectives: to determine what knowledge professional caregivers in residential centres have about behavioural and psychological symptoms of dementia; to evaluate how behavioural and psychological symptoms associated with dementia are managed by professional caregivers in residential centres; and to know the training needs perceived by professional caregivers in behavioural and psychological symptoms of dementia. Professionals (in the fields of psychology, nursing coordination and geriatric assistance) from residential centres for the elderly were interviewed and a qualitative analysis of the interviews was carried out. The results show that most professionals do not know the behavioural and psychological symptoms of dementia or how to cope with them and have low levels of knowledge. This study highlights the need to design and provide ongoing training in the residential setting on the management of these symptoms.

scholarly journals Sequential drug treatment algorithm for agitation and aggression in Alzheimer’s and mixed dementia

2018 ◽  
Vol 32 (5) ◽  
pp. 509-523 ◽  
Author(s):  
Simon JC Davies ◽  
Amer M Burhan ◽  
Donna Kim ◽  
Philip Gerretsen ◽  
Ariel Graff-Guerrero ◽  
...  
Keyword(s):  
Drug Treatment ◽  
Psychological Symptoms ◽  
Treatment Algorithm ◽  
Future Research ◽  
Evidence Based ◽  
Hospital Inpatient ◽  
Mixed Dementia ◽  
People With Dementia ◽  
Behavioural And Psychological Symptoms ◽  
Sequential Trials

Introduction: Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. Methods: A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer’s and mixed Alzheimer’s/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. Results: After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. Conclusion: This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer’s/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.

A systematic review of the association between individual behavioural and psychological symptoms in dementia and carer burden

2020 ◽  
Vol 24 (3) ◽  
pp. 181-203
Author(s):  
Catriona George ◽  
Nuno Ferreira ◽  
Rosalind Evans ◽  
Victoria Honeyman
Keyword(s):  
Systematic Review ◽  
Psychological Symptoms ◽  
Psychotic Symptoms ◽  
Specific Symptom ◽  
Content Type ◽  
Carer Burden ◽  
Effective Interventions ◽  
Behavioural And Psychological Symptoms ◽  
Focus Analysis

Purpose The purpose of this paper was to systematically review the association between behavioural and psychological symptoms of dementia (BPSD) and the development of carer burden. Although this association has been well established in the literature, it is not clear whether there are individual symptoms or clusters of symptoms that are particularly burdensome for carers. Design/methodology/approach A systematic review of the available literature was carried out to determine whether any specific symptom or cluster of symptoms was most closely associated with carer burden. In addition, the categorisation of behavioural symptoms, conceptualisations of burden and methods of measurement used were examined and quality of the studies appraised. Findings A total of 21 studies measured the association between at least one individual symptom or symptom cluster and carer burden, with all studies finding at least one symptom to be significantly associated with burden. The majority of studies were of fair to good quality. However, there was considerable heterogeneity in focus, analysis, recruitment and measurement of behaviour and burden. Originality/value Symptoms, which were found to be significantly associated with carer burden, were aggression/agitation, frontal systems behaviour, disinhibition, disrupted eating and sleeping behaviour, unusual motor behaviour, anxiety and psychotic symptoms. However, because of the heterogeneity of studies, there was insufficient evidence to establish whether any symptoms are more important than others in the development of carer burden. Future focus on clarifying the dimensions of carer burden and the mechanisms by which BPSD impact negatively on carers could inform the development of effective interventions.

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