Recommendations for the management of behavioral and psychological symptoms of dementia

Background: The behavioral and psychological symptoms of dementia (BPSD) ar e common. serious problems that impair the quality of life for both patient and caregiver. In order to provide recommendations based upon the best ava ilable evidence, a qualitative literature review was performed. Methods: A search of the English language medical literature published between 1966 an d 2000 was performed. The quality of the studies was assessed by considerin g the subjects, trial design, analysis and results. Final recommendations w ere based upon the quality of available evidence. Results: The management o f BPSD begins with a thorough assessment to search for underlying causes of behaviour change. Concomitant medical illness should be treated and sensor y impairment ameliorated. Nonpharmacological approaches should be institute d prior to medication use. These interventions include music, light, change s in level of stimulation and specific behavioral techniques. Antipsychotic s are the best studied pharmacological intervention for agitation and aggre ssion and have demonstrated modest but consistent efficacy. Antidepressants such as trazodone and selective serotonin re-uptake inhibitors. as well as anticonvulsants such as carbamazepine and valproic acid have also demonstr ated efficacy. Benzodiazepines can be used for short-term treatment as p.r. n. agents when necessary. Pharmacotherapy must be monitored closely for bot h effectiveness and side effects, with consideration of medication withdraw al when appropriate. Conclusion: The management of BPSD can significantly i mprove the quality of life for the patient and caregiver. Their assessment and management are essential components of the treatment of dementia.