[State of the art management of BPSD in dementia]

Abstract

Objective: To obtain a cross-sectional overview of therapeutic practice concerning non-cognitive, behavioral signs and symptoms of dementia (BPSD) in Germany, Austria, and Switzerland.

Method: We selected 24 psychiatrists (8 from each country) for a questionnaire-based survey with 28 detailed practical questions.

Results: Attitudes and preferences were in line with the state of the art as documented in the literature, with the exception of the fact that 30 % of the physicians favored a too brief therapeutic trial with selective serotonin re-uptake inhibitors (SSRIs) for agitation. According to the international literature the preferred treatment of psychotic symptoms in Parkinsons's disease is also a little bit different. Modern atypical antipsychotics, and particularly risperidone, were highly favored for agitation, delirium, psychotic symptoms, and rage outbursts; benzodiazepines (oxazepam and lorazepam), and to an extent also low-potency conventional antipsychotics, were favored only for brief ad hoc medication courses. Anxiety and depressive symptoms were preferentially treated with SSRI, with the exception of short-term therapy of generalized anxiety where benzodiazepines were favored. Benzodiazepines and zolpidem were favored for insomnia without pronounced nocturnal agitation.

Conclusion: Psychiatrists at memory clinics in German-speaking Europe have therapeutic attitudes and practices that are consistent with the current state of the art.