Behavioural and psychological symptoms of dementia (BPSD) are common and negatively affect patient and caregiver outcomes
Nearly all people living with dementia develop BPSD.1 Symptoms vary over time and by type of dementia, and can include agitation, psychosis, depression, apathy, and anxiety.1,2 Recognizing and addressing new behavioural or mood symptoms is crucial, as BPSD is associated with increased hospital admissions, institutionalization, functional decline, and caregiver distress.
Nonpharmacologic interventions are effective first-line treatments for mild BPSD
Nonpharmacologic interventions (described in Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.241076/tab-related-content) include caregiver education, sensory and cognitive stimulation, psychological approaches, and environmental modifications.1 Nonpharmacologic interventions have limited adverse effects, are more effective than pharmacotherapy for managing less severe symptoms, and should be considered for all patients with BPSD.2–4 Pharmacotherapy may be required to manage substantial patient distress, physical agitation, or psychosis.1,2
Identifying BPSD triggers can guide nonpharmacologic interventions
Acute medical issues should be ruled out in all patients with new or worsening BPSD. Unmet social, emotional, or psychological needs such as loneliness, emotional distress, or boredom may respond to sensory, cognitive, and psychological interventions.1–4 Caregiver distress should be identified and addressed.1–4 Environmental modifications can assist with BPSD resulting from changes in routine, or over- or understimulation.1–4
Certain nonpharmacologic interventions are most effective for specific symptoms
Agitation symptoms may benefit from preferred music and massage.1–4 Anxiety may improve with music and cognitive behavioural therapy.1–4 Depressive symptoms may respond to massage or touch therapy, robotic pets, cognitive stimulation, physical exercise, and reminiscence therapy.1–4 Getting lost can be managed with secured environments and by disguising exits.1–4
Caregiver interventions are effective for reducing frequency and severity of BPSD
Caregiver interventions should be considered in all cases. Effective interventions are multicomponent, and include psychoeducation to facilitate knowledge and emotional understanding, skills training to manage challenging behaviours, and emotional or practical supports.1,3,4 Interventions should be personalized for patients and caregivers.1,2,5
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Supplementary Information
Footnotes
Competing interests: Lesley Wiesenfeld reports holding leadership roles as chief of psychiatry, chair of the Medical Advisory Committee, and member of the Board of Directors at Sinai Health until January 2025. No other competing interests were declared.
This article has been peer reviewed.
References
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