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Review
. 2013 Apr;19(2 Dementia):382-96.
doi: 10.1212/01.CON.0000429177.14354.83.

The clinical problem of neuropsychiatric signs and symptoms in dementia

Anna Burke  1 , Geri Hall, Pierre N Tariot
Affiliations
Review

The clinical problem of neuropsychiatric signs and symptoms in dementia

Anna Burke et al. Continuum (Minneap Minn). 2013 Apr.

Abstract

Purpose of review: This article reviews behavioral signs and symptoms of dementia that can lead to increased mortality, excessive cognitive and functional disability, early institutionalization, and increased caregiver burnout.

Recent findings: Almost all patients with a dementia will develop significant behavioral disturbances at some point over the course of their illness. These behavioral signs and symptoms rarely fit into usual diagnostic classifications or meet full criteria for a formal major psychiatric disorder.

Summary: Treatment of behavioral signs and symptoms of dementia should include both pharmacologic and nonpharmacologic interventions. There are currently no treatments for these disturbances approved by the US Food and Drug Administration. Best judgment should be used in identifying dominant target symptoms and matching them to the most relevant drug class. Implementing nonpharmacologic interventions before the development of neuropsychiatric symptoms may prevent triggers related to a progressively lowered stress threshold and therefore is key in the treatment of all patients with a dementia.

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Figures

Figure 5-1.
Figure 5-1.
Prevalence of neuropsychiatric symptoms in dementia using the neuropsychiatric inventory. Data from Lyketsos CG, et al, Am J Psychiatry. ajp.psychiatryonline.org/article.aspx?articleid=174106.
Figure 5-2.
Figure 5-2.
Progressively lowered stress threshold in people with dementia. This figure represents how the individual’s capacity to cope with stress and stimuli diminishes over the course of dementing illness. Over time the capacity to cope decreases, resulting in less calm baseline behavior and increased noncognitive behavioral symptoms (NCBS). Anxiety and increased psychomotor agitation always precede the onset of NCBS. Steps can be taken to intervene when anxiety occurs to thereby prevent NCBS. The x axis represents the timeline for the disease trajectory. The dotted line represents how stress builds throughout any given day to produce anxiety and NCBS. The y axis represents the degree of stress/stimulus the patient is able to manage before developing NCBS. Reprinted from Hall G, Buckwalter K. Arch Psychiatr Nurs. © 1987, with permission from Elsevier.
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References

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    1. Lyketsos CG,, Steinberg M,, Tschanz JT, et al.. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry 2000; 157 (5): 708–714. - PubMed
    1. Hall G,, Buckwalter K. A conceptual model for planning and evaluating care of the client with Alzheimer’s disease. Arch Psychiatr Nurs 1987; 1 (6): 399–406. - PubMed

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