Behavioral Symptoms

Behavioural and psychological Symptoms in Dementia

Remember the dementia patients are having a hard time, not giving us a hard time

About 90% of Persons with dementia resulting from any cause, not only have cognitive decline and loss of function but also develop personality changes, altered behaviours, and psychological symptoms called Neuropsychiatric symptoms or Behavioural and Psychological symptoms of Dementia {BPSD}. These symptoms are very challenging and distressing both for the person living with dementia, their caregivers and families.

The Behavioral and Psychological symptoms can be grouped into:

Cognitive or Perceptual – Delusions (believing things that are not true, such as being harmed or stolen from) Hallucinations (seeing, hearing, smelling or tasting things that are not real).

Motor – Pacing, wandering, repetitive movements, physical aggression.

Verbal – Yelling, calling out, repetitive speech, verbal aggression. Emotional – Euphoria, depression, apathy, anxiety, irritability. Vegetative – Disturbances in sleep and appetite.

BPSD are caused by multiple factors. Neuropsychiatric symptoms relate to interactions between an

individual’s biology, prior experiences and current environment. Dementia related agitation, disinhibition, and psychosis are associated with volume reductions and decreased metabolism in the regions of the brain that mediate emotional regulation, self-awareness and perception.

BPSD also correlate with cholinergic, noradrenergic, dopaminergic, serotonergic and glutamatergic neurotransmission imbalances. Neurotransmitters are chemical substances in the brain that act as messengers that transmit signals between nerve cells, muscles and glands. They are essential for the body’s function, affecting many aspects of life, including:

Thoughts and emotions: neurotransmitters influence mood, memory and learning. Movement: neurotransmitters control muscle contraction.

Organ function: neurotransmitters regulate the cardiovascular and endocrine systems. Sleep patterns: Neurotransmitters regulate sleep patterns.

This evidence forms the basis for the pharmacotherapies currently used to treat BPSD.

The other important factors that are found to cause BPSD are: Pre – morbid Neuroticism – Prior to the onset of dementia having a personality trait characterized by a tendency to respond to challenges with exaggerated negative emotions such as anxiety, depression, and anger.

Pre – morbid, post – traumatic stress disorder – Prior to the onset of dementia the person would have been affected mentally by a grave tragic incident in their life.

Problematic Caregiver communication styles.

Environmental Factors causing BPSD: Unmet needs for food, fluid, companionship. Behavior or learning – when unwanted behavior is unwittingly reinforced, such as by providing attention when a patient calls out.

Patient-Environment mismatch: when a

caregiver’s expectations exceed a patient’s

capability.

sensory over or under stimulation, or surroundings that are too hot, cold, or loud.

BPSD are prevalent and affect the prognosis and treatment of dementia. These symptoms have to be managed with medications, non- pharmacologic therapies along with caregivers training.

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