Management of the behavioral and psychological symptoms of dementia

Figures & data

Table 1 Common scales used for measuring the behavioral manifestations of dementia

Test name	Test description
Cohen-Mansfield Agitation Inventory (CMAI)	Developed in 1986. It examines 29 types of agitated behavior, including pacing, verbal or physical aggression, repetitious mannerisms, screaming and general restlessness.a
Neuropsychiatric Inventory: Nursing Home version (NPI-NH)	Assesses 12 behavioral disturbances: delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, nighttime behavior disturbances and appetite and eating abnormalities.b
Behavioral Pathology in AD (BEHAVE-AD)	Developed in 1987. It is a structured psychiatric interview, assessing 25 behaviors in 7 areas: paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness, diurnal rhythm disturbances, affective disturbance and anxieties and phobia.c
Clinical Global Impression of Change (CGI-C)	Establishes a global rating of all aspects of the patient’s condition.
Functional Assessment Staging scale (FAST)	Measures the levels of basic activities such as bathing and toileting, and rates patients from independent to totally dependent.

^a Ballard et al 2006; Kozman et al 2006.

^b Carson et al 2006.

^c Carson et al 2006; Kozman et al 2006.

Table 2 Behavioral management interventions

Activity associated with potential BPSD	Intervention
Bathing	Make a safe bathroom. Be prepared, don’t rush. Ensure room and water temperature are comfortable. Wash hair last. A recent study found benefit of person-centered bathing and towel bath in decreasing agitation and discomfort.a
Dressing	Limit choices. Prepare clothing. Give specific cues. Provider larger clothing and soft stretchy fabrics. Provide duplicate outfits and comfortable shoes with Velcro. Give positive reinforcement.
Eating	Maintain a regular mealtime. Avoid distraction at meals. Check the food temperature. Honor preferences when possible, and offer finger foods.
Wandering	Provide adequate daily physical activity. Create a safe environment and safe wandering paths. Remove reminders of leaving (coats, umbrella). Have alarms or bells at exit doors. ID bracelet and “Safe Return” programs are available.
Incontinence	Scheduled voiding. Be attentive to nonverbal cues (such as pacing). Simplify clothing and clear obstacles. Put signs (including pictures) at the bathroom door. Give positive reinforcement.

^a Sloane et al 2004.

BallardCWaiteJBirksJ2006Atypical antipsychotics for aggression and psychosis in Alzheimer’s DiseaseCochrane Database of Systematic Reviews1CD003476

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KozmanMWattisJCurranS2006Pharmacological management of behavioral and psychological disturbance in dementiaHum Psychopharmacol Clin Exp21112

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CarsonSMcDonaghMPetersonK2006A systematic review of the efficacy and safety of atypical antipsychotics in patients with psychological and behavioral symptoms of dementiaJ Amer Geri Soc5435461

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SloanePHoefferBMitchellC2004Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trialJ Amer Geri Soc521795804

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