Behavioural and psychological symptoms of dementia (BPSD)

Behavioural problems are common in dementia including Alzheimer’s type and can occur at any stage of the disease. They behavioural issues could present in different ways including:

  • Anger outbursts, irritability and aggression (verbal and physical)
  • Socially inappropriate behaviour (sexual disinhibition, attention seeking, inappropriate urination)
  • Other symptoms like wandering or hoarding behaviour

Psychological symptoms

These can include depression, anxiety, apathy, paranoia, delusions and hallucinations.

Non-medical management advice

  1. Creating a safe, caring environment with a predictable routine can be very helpful.
  2. Simple memory enhancement techniques to improve coping like calendars, alarms and lists.
  3. Encourage physical and mental activity including social activites and day centres.
  4. Simplifying medication for example by requesting a dossette box (which has medication separated depending on time and day) helps.
  5. Organising carers to assist with activities of daily living (like cooking, washing, cleaning, prompting medications).
  6. Education for patient and families about dementia and how to cope during different stages of the disease.
  7. Looking at support for caregivers including counselling and local support groups (usually ran by voluntary agencies).
  8. Trying to identify any reversible causes of behaviour changes (sometimes infections or other physical symptoms like constipation can be the cause).
  9. An occupation therapy home assessment can be useful to identify any hazards and improve safety for the patient.
  10. Activities may reduce boredom, wandering and aggression. Programs can usually be found in your local area.
  11. Effective therapies like music, exercise, aromatherapy have all shown to be helpful. Simple interventions like distraction and reassurance can help especially if a patient suffers with delusions or hallucinations.

Medication Options

In certain circumstances low doses of medication may be required to help with a patient’s agitation and behavioural disturbance. Usually an antidepressant or anti-anxiety medication is tried first. Examples include citalopram, trazodone, diazepam. A doctor will assess first whether all non-medical alternatives have been looked at first and other causes of the change in behaviour have been ruled out.