Management of behavioral disorders in dementia patients.

Behavioral disorders are major manifestations of Alzheimer's disease and ot her forms of dementia. They are associated with caregiver distress, increas e the likelihood of institutionalization and may be associated with more ra pid cognitive decline. The first step of treatment strategy is an assessmen t of these disorders. Treatment of behavioral signs is an etiological treat ment. Acute behavioral signs are often related to an unknown somatic diseas e. Chronic signs are often symptoms of the neurological dementia and can be reduced, especially by serotonergic agents and anticonvulsivants. The new antipsychotics are a good alternative to classic neuroleptics known for the ir frequent cognitive side effects in demented patients. Anticholinesterasi c drugs can positively influence noncognitive signs. The treatment of behav ioral and psychological symptoms of dementia (BPSD) involves a number of sp ecific interventions including cognitive stimulation which has shown effect iveness on both cognitive functions and quality of life. Prevention of BPSD includes safety measures such as evaluation of suicidality and violence, v igilance regarding neglect and abuse, planning for legal issues due to the patient's incapacity. Families or caregivers should be provided with counse ling, education and support. The treatment of BPSD is part of a global and multimodal care which involves general practioners, nurses, social workers, physiotherapists, neuropsychologists, speech therapists, memory centers, p sychogeriatric and geriatric units, and respite care units, nursing homes a nd long-term care facilities. The coordination of the professionals is a cr itical aspect of providing effective care for patients with Alzheimer's dis ease.