Tailoring the therapeutic interventions for behavioral and psychological symptoms of dementia

ABSTRACT

Introduction

Behavioral and psychological symptoms of dementia (BPSD) are symptoms of non-cognitive nature, which frequently develop during the course and different stages of dementia. The diagnosis of BPSD is complex due to symptom variety, and relies on detailed clinical evaluation and medical history. Accurate assessment of BPSD is crucial in order to tailor therapeutic intervention (non-pharmacological and pharmacological) for each individual and monitor patient response to therapy.

Areas covered

This review encompasses the epidemiology, classification, assessment and etiology of BPSD, as well as their impact on caregiver distress, and gives an overview of current and emerging non-pharmacological and pharmacological therapeutic options, as well as potential BPSD biomarkers, in order to provide a framework for improving BPSD diagnosis and developing novel, targeted and specific therapeutic strategies for BPSD.

Expert opinion

Due to the large heterogeneity of BPSD and of the fact that drugs available only alleviate symptoms, finding an adequate treatment is very challenging and often involves a polytherapeutic approach. Non-pharmacologic interventions have shown promising results in improving BPSD, however further research is needed to confirm their beneficial effects. Thus, the modification of pre-existancing as well as the development of novel pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy.

KEYWORDS:

• Assessment
• behavioral and psychological symptoms
• classification
• dementia
• etiology
• impact
• prevalence
• therapy

Article highlights

• BPSD occur frequently and represent a significant problem in clinical practice, due to high prevalence, severity and burden, as well as therapy often being non-effective

• The etiology of BPSD is still unclear; however, it involves complex interactions of various biopsychosocial factors

• In addition to the patient, BPSD can also negatively affect the caregiver’s general health and quality of life

• Both pharmacologic and non-pharmacologic solutions should be considered for BPSD therapy

• Due to symptom variety, choosing adequate BPSD treatment is challenging and often includes a personalized and polytherapeutic approach

• Person-centered therapeutic approach to BPSD needs to be tailored based on dementia stage, behavioral and cognitive symptoms, comorbidities, physical fitness and individual preferences

Acknowledgments

The authors thank Nicholas J. Bradshaw for editing the English language.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was supported by the Croatian Science Foundation, project no. IP-2019-04-6100.