Managing the Behavioral & Psychological Symptoms of Dementia
What is BPSD?
Behavioral and Psychological Symptoms of Dementia or BPSD refers to a collection of non-cognitive symptoms that are often distressing, such as agitation and aggression, and usually occurring together in an individual with dementia. The International Psychogeriatric Association explains BPSD as including thought content, disturbed perception, mood or behavior that frequently occurs in people with dementia.
According to the NHS guidelines for the Management of Patients with Dementia, the spectrum of symptoms usually includes aggression, agitation or restlessness, anxiety, depression, repetitive vocalization, cursing and swearing, sleep disturbance, shadowing or closely following the caregiver, sundowning or a worsening of behavior after 5pm, wandering, psychosis (including delusions and hallucinations) and non-specific behavior disturbance, such as hoarding.
Behavioral Problems Associated With Dementia
Prevalence of BPSD
A study on the Prevalence, correlates and course of behavioral and psychological symptoms of dementia in the population, published in 2009 in The British Journal of Psychiatry, found that the “behavioral and psychological symptoms of dementia affect nearly all people with dementia. Symptoms co-occur, and the symptoms that affected individuals experience are related to their socio-demographic and clinical characteristics.”
In addition, The Best Practice Advocacy Centre New Zealand says that this collection of observable symptoms typically occurs in the later stages of dementia, with the frequency of BPSD increasing in correlation with the severity of dementia, although the course of this cluster of symptoms might vary from person to person. While hallucinations and mild depression is usually resolved within a few months of treatment, agitation, severe depression and delusions tend to be more persistent.
BPSD can lead to severe burden not only for the person suffering from dementia but also for the caregiver. Given that this cluster of symptoms is usually caused by neurobiological changes that increase vulnerability to external triggers, the primary target of treatment, as well as prevention of BPSD, becomes external factors. This is why psychosocial and psychotherapeutic interventions work best, in combination with medication for the cognitive and neurological degeneration brought about by dementia.
According to research published by German Societies for Psychiatry and Psychotherapy and Neurology and translated to English by PubMed, pharmacological treatment is only initiated for BPSD when psychological interventions are found to be insufficient or ineffective.
Behavioral therapy has traditionally used the principles of learning and conditioning to create strategies aimed at the elimination or suppression of undesirable behaviors. However, more recently, approaches like Cognitive Behavior Therapy (CBT), have focused on “positive programming” through non-aversive means with the aim of developing more functional behaviors, says a study on Non-Pharmacological Interventions in Dementia, published in the British Journal of Psychiatry. The methods used today focus on person-centered care, which first assesses the triggers for each individual’s BPSD, the specific behaviors and the reinforcers of these behaviors. A plan of therapy is developed based on this assessment.
In fact, an Alzheimer’s and Dementia program, called Hearts in the Past, run by SeaCrest Village, found that using a combination of a soothing environment, intergenerational programs, pet therapy and daily activity helped bring about a feeling of well-being in those experiencing BPSD.
Cognitive Behavior Therapy
The reason why CBT works is that is focuses on the “here and now,” rather than trying to resolve past issues. In order to effect an improvement in an individual’s current situation, the therapist works with the client to identify triggers to distress, which is then used to focus on developing effective means of thinking and behaving in different situations, says an article on Talking Therapies published by the Alzheimer’s Society. The use of relaxation and breathing techniques helps reduce levels of anxiety, agitation and aggression. The focus is also to include experiences that are enjoyable for the individual.
Other Forms of Therapy
Research has also shown that various other types of therapy, individually or in combination, can prove beneficial in coping with the behavioral and psychological symptoms of dementia. For instance, a study published in the Journal of Clinical Psychiatry found that individualized music therapy, bright light treatment or BLT and aromatherapy helped improve some of the behavioral symptoms.
Research published the Journal of Clinical Interventions in Aging has also shows the efficacy of pet therapy, good sleep hygiene, avoiding alcohol and caffeine and adequate physical activity during the daytime can help people with BPSD, especially for those with depression and sleep disturbance.