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Nonpharmacological Management of BPSD: Agitation and Behavioral Problems in Dementia

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Geriatric Practice

Abstract

Caregivers identify BPSD as one of the most challenging and distressing aspects of care. The presence of BPSD, especially physical aggression, is a leading cause of nursing home placement. These behaviors can have an immense impact on the quality of life of both the patient and the caregiver. This chapter has been created to help the primary care provider have a structured approach to the evaluation and management of BPSD.

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Authors and Affiliations

  1. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA

    Christine Chang

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Correspondence to Christine Chang .

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  1. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Audrey Chun

Appendices

Appendix 1: Confusion Assessment Method (CAM) Diagnosis of Delirium Requires a Present or Abnormal Rating for Criteria 1 and 2 Plus Either 3 or 4 [28]

Criteria

  1. 1.

    Acute onset and fluctuating course:

    • Is there evidence of an acute change in mental status from the patient’s baseline? Corroboration with caretakers and family member is usually required.

    • Did this behavior come and go or wax or wane in severity in the last 24 hours?

  2. 2.

    Inattention:

    • Does the patient have difficulty focusing attention?

    • Are they easily distracted?

    • Do they have difficulty keeping track of what is being said?

    • Consider asking the patient to recite the days of the week backwards.

  3. 3.

    Disorganized thinking:

    • Is the patient’s speech disorganized or incoherent?

    • Does the patient ramble or have irrelevant conversation that is unclear with illogical flow of ideas, and unpredictable switching between subjects?

  4. 4.

    Altered level of consciousness:

    • Only patients who are calm and alert are considered normal.

    • Patient meet criteria if they are: vigilant (hyperalert), lethargic (drowsy, easily aroused), stuporous (difficult to arouse), or comatose.

Appendix 2: Blackbox Warning for Antipsychotics [17, 64]

  • Increased risk of mortality. Rate of death was 1.6–1.7 times that of placebo (3.5 vs 2.3%).

  • Death appeared to be heart related or from infections (e.g., pneumonia).

  • Often causing diabetes mellitus, hyperglycemia, ketoacidosis, and hyperosmolar states.

  • All antipsychotic drugs will now include the same information about this risk in a BOXED WARNING and WARNING section.

  • Antipsychotics are NOT indicated for the treatment of dementia-related psychosis and are off-labeled use.

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Chang, C. (2020). Nonpharmacological Management of BPSD: Agitation and Behavioral Problems in Dementia. In: Chun, A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_21

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