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1. 2. 3. 4. 5. 6. 7. Definition Consequences Prevalence Presentation in early dementia Presentation in dementias of different origin Treatments Conclusions
1. BPSD definition
International Psychogeriatric Association 1996 Consensus Conference: BPSD Behavioral and Psychological (Signs and) Symptoms of Dementia
describes a heterogenous range of psychological reactions, psychiatric symptoms and behaviors occuring in people with dementia of any etiology
IPA BPSD 2002 EAMA 01.2006 & SBMI 12.2006
2. BPSD Consequences
Decreased QOL patient, family, caregivers Increased caregiver burden Over-medication Premature institutionalisation Physical restraint High cost
Finkel S.I. Clin GeriatrMed 19 (2003) 799-824
EAMA 01.2006 & SBMI 12.2006
3. BPSD prevalence
In 90 % of demented people Reisberg et al. 1989 Almost all demented patients suffer from BPSD during a period Hope, Reine 1999 BPSD often brings up diagnosis dementia
Assal, Cummings 2002
Psychological
Affect-mood anxiety, depressive symptoms apathy irritability Thought, perception delusions hallucinations misperceptions Vegetative symptoms sleep disturbances sexual behavior appetite
Desai, Grossberg 2001
frequency (% patients)
80
Diurnal rhythm
Agitation Irritability Aggression Wandering Anxiety Accusatory Hallucinations Mood change Socially unaccepted Delusions Sexually inappropriate
60 40
20 0 40
Suicidal ideation
0 30 20 10
EAMA 01.2006 & SBMI 12.2006
10
20
30
6. BPSD treatment
Many behavioral disturbance are not amenable to pharmacotherapy (wandering, hoarding); some can be improved Non-pharmacological interventions (mild moderate stages) : educating family, caregivers
Desai, Grossberg 2001
Drugs
Atypical antipsychotics SSRI Benzodiazepines Anticonvulsivants, atyp. antipsychotics
Finkel 2001, Lee 2004
Acetylcholinesterase inhibitors ?
Finkel 2004
EAMA 01.2006 & SBMI 12.2006