Assessing behavioural and psychological symptoms of dementia

Over 90% of patients with dementia will experience behavioural and psychological symptoms of dementia (BPSD). These symptoms can have a significant effect on the patient and their family, carers or significant others, and precipitate entry into residential aged care—see Examples of behavioural and psychological symptoms of dementia for examples of BPSD.

Figure 1. Examples of behavioural and psychological symptoms of dementia

Delusions—distressing beliefs [NB1]

Hallucinations [NB1]

Agitation—easily upset, repeating questions, arguing or complaining, hoarding, pacing, inappropriate screaming, crying out or disruptive sounds, rejection of care (eg bathing, dressing, grooming), leaving home

Aggression—physical or verbal

Depression or dysphoria

Anxiety—worrying, shadowing (ie following carer)

Apathy or indifference

Disinhibition—socially or sexually inappropriate behaviour

Irritability or lability

Motor disturbance—repetitive activities without purpose (eg wandering, rummaging)

Night-time behaviours—waking and getting up at night

Note: NB1: Hallucinations and delusions are psychotic symptoms of dementia.

Behavioural and psychological symptoms of dementia are multifactorial, often arising or worsening as dementia progresses and the patient loses the ability to communicate. Before starting treatment for a behavioural and psychological symptom of dementia, address factors that could precipitate the behaviour, see Factors that can precipitate behavioural and psychological symptoms of dementia.

Figure 2. Factors that can precipitate behavioural and psychological symptoms of dementia.

[NB1]

the patient’s unmet needs, including:
- boredom (ie lack of activity)
- constipation
- dehydration
- fatigue from poor sleep
- frustration
- incontinence or urinary retention
- lack of access to glasses or hearing aids
- loneliness
- malnutrition or dietary deficiencies
- pain
- lack of routine
carer workload and distress—consider whether more support or education is required; see Supporting families, carers or significant others of people with dementia
delirium (if the change is acute) and its causes (eg drugs, infection)
unsuitable environment for the patient (eg overstimulation, under-stimulation, unsafe, uncomfortable temperature)
a pre-existing psychiatric disorder

Note: NB1: Impaired ability to communicate the above factors is a key reason for behavioural and psychological symptoms of dementia.

Try to understand the behaviour in the context of the patient’s life story (including cultural, religious or social norms) and personality—seek information from people familiar with the patient before and while affected by dementia.

Behavioural and psychological symptoms of dementia are often temporary. Carefully analyse and record the cause, frequency, severity and timing of the behaviour. The Dementia Outcomes Measurement Suite [URL] has a comprehensive list of tools to assess behavioural and psychological symptoms of dementia.

Create a plan to prevent and manage behavioural and psychological symptoms of dementia with the patient and their significant other(s) and/or carer(s).

For advice on assessing depressive symptoms in dementia, see here.

Dementia Behaviour Management Advisory Service (DBMAS) has a 24-hour helpline (1800 699 799) that provides expert advice and support to staff and carers of people with challenging behaviour of dementia in the community and in acute, primary care or residential aged-care settings.

If behavioural and psychological symptoms of dementia place the patient or others at risk of harm, see Nonpharmacological management of behavioural and psychological symptoms of dementia and Pharmacological management of behavioural and psychological symptoms of dementia. Referral to the Specialist Dementia Care Program (SDCP) may be appropriate until symptoms have reduced or stabilised.