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Questions and Answers
Which class of medications, when withdrawn, is LEAST likely to contribute to Behavioral and Psychological Symptoms of Dementia (BPSD)?
Which class of medications, when withdrawn, is LEAST likely to contribute to Behavioral and Psychological Symptoms of Dementia (BPSD)?
- Benzodiazepines
- Opioids
- Antidepressants
- Antibiotics (correct)
A patient with dementia exhibits worsening agitation despite increasing doses of antipsychotics. What condition should be primarily considered?
A patient with dementia exhibits worsening agitation despite increasing doses of antipsychotics. What condition should be primarily considered?
- Pain
- Akathisia (correct)
- Depression
- Urinary Retention
Which of the following is NOT a recommended area to address when assessing the comfort of a patient with dementia and BPSD?
Which of the following is NOT a recommended area to address when assessing the comfort of a patient with dementia and BPSD?
- Urinary Retention
- Pain
- Constipation
- Financial Status (correct)
What percentage range of dementia patients are estimated to experience pain?
What percentage range of dementia patients are estimated to experience pain?
Which of the following is LEAST likely to be useful in assessing pain in advanced dementia?
Which of the following is LEAST likely to be useful in assessing pain in advanced dementia?
Why is establishing a baseline of BPSD critically important?
Why is establishing a baseline of BPSD critically important?
Which of the following is NOT evaluated by the Neuropsychiatric Inventory (NPI)?
Which of the following is NOT evaluated by the Neuropsychiatric Inventory (NPI)?
Which of the following can contribute to agitation and apathy in patients with dementia?
Which of the following can contribute to agitation and apathy in patients with dementia?
Which of the following behavioral disturbances is MOST commonly observed in the evening among patients with dementia, a phenomenon known as 'sundowning'?
Which of the following behavioral disturbances is MOST commonly observed in the evening among patients with dementia, a phenomenon known as 'sundowning'?
A patient with frontotemporal dementia is being assessed for Behavioral and Psychological Symptoms of Dementia (BPSD). Based on the information provided, which symptom would be MOST characteristic of this type of dementia?
A patient with frontotemporal dementia is being assessed for Behavioral and Psychological Symptoms of Dementia (BPSD). Based on the information provided, which symptom would be MOST characteristic of this type of dementia?
A patient with a history of Alzheimer's disease presents with new-onset agitation and delusions. Initial history and physical examination are unremarkable. Which of the following is the MOST appropriate next step in the evaluation?
A patient with a history of Alzheimer's disease presents with new-onset agitation and delusions. Initial history and physical examination are unremarkable. Which of the following is the MOST appropriate next step in the evaluation?
What is the PRIMARY role of the physical examination in the evaluation of Behavioral and Psychological Symptoms of Dementia (BPSD)?
What is the PRIMARY role of the physical examination in the evaluation of Behavioral and Psychological Symptoms of Dementia (BPSD)?
A patient with dementia is admitted to the hospital due to worsening agitation and aggression. The symptoms developed subacutely over the past week. Which of the following laboratory investigations is MOST warranted?
A patient with dementia is admitted to the hospital due to worsening agitation and aggression. The symptoms developed subacutely over the past week. Which of the following laboratory investigations is MOST warranted?
Which factor, related to medication, is MOST important to identify during history intake for patients with Behavioral and Psychological Symptoms of Dementia (BPSD)?
Which factor, related to medication, is MOST important to identify during history intake for patients with Behavioral and Psychological Symptoms of Dementia (BPSD)?
A patient with vascular dementia is exhibiting Behavioral and Psychological Symptoms of Dementia (BPSD). Which of the following symptoms is MOST commonly associated with vascular dementia?
A patient with vascular dementia is exhibiting Behavioral and Psychological Symptoms of Dementia (BPSD). Which of the following symptoms is MOST commonly associated with vascular dementia?
Why is neuroimaging particularly important in patients with suspected frontotemporal dementia?
Why is neuroimaging particularly important in patients with suspected frontotemporal dementia?
What is the typical range of median survival for dementia patients after diagnosis, according to the information provided?
What is the typical range of median survival for dementia patients after diagnosis, according to the information provided?
A patient with known dementia presents with an acute change in behavior, characterized by increased confusion and agitation. The family reports this change occurred over the past 24 hours. Which of the following conditions should be the HIGHEST priority to rule out?
A patient with known dementia presents with an acute change in behavior, characterized by increased confusion and agitation. The family reports this change occurred over the past 24 hours. Which of the following conditions should be the HIGHEST priority to rule out?
A patient begins Citalopram at 10mg daily for BPSD. After 3 weeks, there is no improvement and no adverse effects have occurred. Which of the following is the MOST appropriate next step?
A patient begins Citalopram at 10mg daily for BPSD. After 3 weeks, there is no improvement and no adverse effects have occurred. Which of the following is the MOST appropriate next step?
What is the likely impact of Behavioral and Psychological Symptoms of Dementia (BPSD) on the progression and outcome of dementia?
What is the likely impact of Behavioral and Psychological Symptoms of Dementia (BPSD) on the progression and outcome of dementia?
What broader societal impact is associated with Behavioral and Psychological Symptoms of Dementia (BPSD)?
What broader societal impact is associated with Behavioral and Psychological Symptoms of Dementia (BPSD)?
Which of the following medications used for BPSD has demonstrated benefit for agitation with an associated increased risk of falls?
Which of the following medications used for BPSD has demonstrated benefit for agitation with an associated increased risk of falls?
Which intervention has demonstrated effectiveness in reducing or delaying nursing home placement for patients with dementia?
Which intervention has demonstrated effectiveness in reducing or delaying nursing home placement for patients with dementia?
A study shows that a medication is correlated with accelerating cognitive decline in patients with dementia. Which of the following medications has this correlation?
A study shows that a medication is correlated with accelerating cognitive decline in patients with dementia. Which of the following medications has this correlation?
Which dose of Ginkgo has shown the MOST consistent benefit for BPSD in randomized, controlled trials?
Which dose of Ginkgo has shown the MOST consistent benefit for BPSD in randomized, controlled trials?
According to the content, which of the following dietary approaches, when combined with pharmacological treatment of hypertension, can result in a decreased risk for incident dementia?
According to the content, which of the following dietary approaches, when combined with pharmacological treatment of hypertension, can result in a decreased risk for incident dementia?
What common behavioral disturbances are frequently observed in patients with primary Central Nervous System (CNS) neoplasms?
What common behavioral disturbances are frequently observed in patients with primary Central Nervous System (CNS) neoplasms?
Which of the following BEST describes the general efficacy of antidepressants for treating depression in patients with dementia, according to a meta-analysis?
Which of the following BEST describes the general efficacy of antidepressants for treating depression in patients with dementia, according to a meta-analysis?
What non-pharmacological intervention has been shown to improve cognitive function in patients already diagnosed with dementia?
What non-pharmacological intervention has been shown to improve cognitive function in patients already diagnosed with dementia?
Which of the following is NOT typically considered an effective pharmacotherapy for agitation or aggression in patients with BPSD?
Which of the following is NOT typically considered an effective pharmacotherapy for agitation or aggression in patients with BPSD?
A physician is considering using a cholinesterase inhibitor for a patient with dementia and BPSD. In which specific case might this be MOST justifiable, despite the general findings?
A physician is considering using a cholinesterase inhibitor for a patient with dementia and BPSD. In which specific case might this be MOST justifiable, despite the general findings?
A patient with BPSD is prescribed Sertraline 50mg daily. After 3 weeks, there is no reported improvement. According to the provided information, what is the MOST appropriate next step regarding the Sertraline dosage?
A patient with BPSD is prescribed Sertraline 50mg daily. After 3 weeks, there is no reported improvement. According to the provided information, what is the MOST appropriate next step regarding the Sertraline dosage?
Which of the following actions is MOST crucial for all members of an interprofessional team managing BPSD?
Which of the following actions is MOST crucial for all members of an interprofessional team managing BPSD?
A patient with BPSD is experiencing increased agitation in the late afternoon. Which intervention should the healthcare team consider FIRST, based on non-pharmacological approaches?
A patient with BPSD is experiencing increased agitation in the late afternoon. Which intervention should the healthcare team consider FIRST, based on non-pharmacological approaches?
How can a pharmacist BEST contribute to the management of BPSD within an interprofessional healthcare team?
How can a pharmacist BEST contribute to the management of BPSD within an interprofessional healthcare team?
In a home setting, what is the PRIMARY benefit of maintaining a log that includes caregiver ratings of symptoms, medications, and instructions from each discipline?
In a home setting, what is the PRIMARY benefit of maintaining a log that includes caregiver ratings of symptoms, medications, and instructions from each discipline?
A clinical psychologist's role in managing BPSD primarily involves:
A clinical psychologist's role in managing BPSD primarily involves:
Why are Citalopram and Sertraline often favored over Paroxetine or Fluoxetine in treating behavioral and psychological symptoms of dementia (BPSD)?
Why are Citalopram and Sertraline often favored over Paroxetine or Fluoxetine in treating behavioral and psychological symptoms of dementia (BPSD)?
A physician is considering using Methylphenidate to treat apathy in an elderly patient with dementia. Which factor should the physician consider?
A physician is considering using Methylphenidate to treat apathy in an elderly patient with dementia. Which factor should the physician consider?
What is the recommended initial dosing strategy for Methylphenidate when treating apathy in patients with dementia?
What is the recommended initial dosing strategy for Methylphenidate when treating apathy in patients with dementia?
What is the minimum recommended trial period at the maximum recommended dose for a medication when treating behavioral and psychological symptoms of dementia (BPSD) before concluding that it is ineffective?
What is the minimum recommended trial period at the maximum recommended dose for a medication when treating behavioral and psychological symptoms of dementia (BPSD) before concluding that it is ineffective?
Why is caregiver education and support considered a vital component in managing behavioral and psychological symptoms of dementia (BPSD) with pharmacotherapy?
Why is caregiver education and support considered a vital component in managing behavioral and psychological symptoms of dementia (BPSD) with pharmacotherapy?
When assessing the effectiveness of a new pharmacotherapy for behavioral and psychological symptoms of dementia (BPSD), what is necessary to establish, except in urgent safety situations?
When assessing the effectiveness of a new pharmacotherapy for behavioral and psychological symptoms of dementia (BPSD), what is necessary to establish, except in urgent safety situations?
In elderly patients without dementia, what was evidenced regarding the use of Citalopram and Methylphenidate?
In elderly patients without dementia, what was evidenced regarding the use of Citalopram and Methylphenidate?
What is the primary reason SSRIs like Citalopram and Sertraline are considered the first-line antidepressant treatment options?
What is the primary reason SSRIs like Citalopram and Sertraline are considered the first-line antidepressant treatment options?
Flashcards
BPSD Symptoms
BPSD Symptoms
Behavioral and psychological symptoms associated with dementia.
Delusions in Alzheimer Disease
Delusions in Alzheimer Disease
Common false beliefs occurring in Alzheimer patients.
Physical Examination Role
Physical Examination Role
Confirm historical data and identify contributing factors to BPSD.
Sundowning
Sundowning
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Common BPSD Symptoms
Common BPSD Symptoms
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Acute Onset Symptoms
Acute Onset Symptoms
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Role of Laboratory Tests
Role of Laboratory Tests
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Urinary Tract Infections
Urinary Tract Infections
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Adverse Effects of Medications
Adverse Effects of Medications
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BPSD
BPSD
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Pain Assessment Tools
Pain Assessment Tools
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Withdrawal Symptoms
Withdrawal Symptoms
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Baseline Assessment
Baseline Assessment
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Neuropsychiatric Inventory (NPI)
Neuropsychiatric Inventory (NPI)
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PAINAD Scale
PAINAD Scale
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History Review
History Review
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Interprofessional Healthcare Team
Interprofessional Healthcare Team
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Role of Nurses in BPSD
Role of Nurses in BPSD
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Non-Pharmacological Interventions
Non-Pharmacological Interventions
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Importance of Communication
Importance of Communication
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Role of Social Workers
Role of Social Workers
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Assessment before medication
Assessment before medication
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Citalopram dose increase
Citalopram dose increase
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Sertraline dose maximum
Sertraline dose maximum
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BPSD and Prazosin
BPSD and Prazosin
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Negative efficacy of certain medications
Negative efficacy of certain medications
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Haloperidol and aggression
Haloperidol and aggression
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Ginkgo for BPSD
Ginkgo for BPSD
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Antidepressants in dementia
Antidepressants in dementia
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SSRI Effectiveness
SSRI Effectiveness
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CNS Neoplasms Behavior
CNS Neoplasms Behavior
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BPSD and Cognitive Deficits
BPSD and Cognitive Deficits
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Citalopram and Methylphenidate
Citalopram and Methylphenidate
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Neurological Evaluation for BPSD
Neurological Evaluation for BPSD
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Adverse Events in Antidepressants
Adverse Events in Antidepressants
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Dosing Strategy for Methylphenidate
Dosing Strategy for Methylphenidate
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Prognosis of Dementia
Prognosis of Dementia
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Evaluating Pharmacotherapy for BPSD
Evaluating Pharmacotherapy for BPSD
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BPSD Impact on Dementia
BPSD Impact on Dementia
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Family Caregiver Burden
Family Caregiver Burden
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Role of Caregivers in BPSD Treatment
Role of Caregivers in BPSD Treatment
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Preventing BPSD Strategies
Preventing BPSD Strategies
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Combining Antidepressants
Combining Antidepressants
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Citalopram Dosing Guidelines
Citalopram Dosing Guidelines
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Depression and Dementia Risk
Depression and Dementia Risk
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Study Notes
Behavioral and Psychological Symptoms in Dementia (BPSD)
- Definition: Dementia is formally called Major Neurocognitive Disorder (MND) and defined by cognitive decline and loss of function (difficulty with daily tasks). BPSD are neuropsychiatric symptoms that accompany dementia. Examples include delusions, hallucinations, apathy, anxiety, depression, disinhibition, pacing, wandering and repetitive movements, aggression, yelling, repetitive speech, verbal aggression, euphoria, irritability, and disturbances in sleep/appetite.
Etiology
- Biopsychosocial Model: No single cause for BPSD, a biopsychosocial model proposes interaction of individual biology, experiences, and current environment.
- Brain regions: BPSD is associated with volume reduction and decreased metabolism in specific brain areas (orbital and dorsolateral prefrontal cortex, anterior cingulate, insula, and temporal lobes) responsible for emotional regulation, self-awareness, and perception.
- Neurotransmitters: BPSD correlates with imbalances in cholinergic, noradrenergic, dopaminergic, serotonergic, and glutamatergic neurotransmission.
- Non-biological factors: Pre-morbid neuroticism, pre-morbid PTSD, caregiver communication styles, and environmental factors (sensory overload/under-stimulation, temperature, noise) can also contribute to BPSD.
Epidemiology
- Prevalence: Worldwide prevalence of dementia was ~44 million in 2016, with a 117% increase from 1990.
- Disability: Dementia is the 5th leading cause of DALYs (Disability-Adjusted Life Years).
- BPSD in Community: Up to 97% of community-dwelling individuals with dementia develop BPSD, often including depression or apathy. Delusions, agitation, and aberrant motor behaviors are common in a proportion of cases.
- Severity: Symptom severity increases with time and correlates with institutional placement.
History and Physical
- History Focus: Prioritize safety risks, assess urgency of intervention, and identify reversible exacerbating factors like environment, medications, pain, and prior psychiatric history.
- Physical Examination: Confirmation of history, identification of other medical conditions, potential causes of discomfort (pain, constipation, urinary retention). Useful tools include PAINAD and FLACC scales for objective pain assessment.
- Sundowning: Behavioral disturbances that occur in the evening, affecting up to 2/3 of patients.
- Psychiatric Conditions: Review of psychiatric history important. Substance use, psychotic, mood, or anxiety disorders should be considered.
Evaluation
- Necessary Tests: No routine tests needed unless history or physical exam suggest alternative causes.
- Urgent need: Acute/subacute onset warrants basic tests like CBC, electrolytes, liver/kidney function, urinalysis, thyroid/toxicology screens and head CT to rule out emergencies.
- Urinary Tract Infections: Staff often erroneously attribute BPSD to UTIs. Routine testing should be targeted only with acute symptoms (fever, dysuria, pain, etc).
Treatment and Management
- Appropriate Setting: Determine appropriate setting (home, hospital, nursing home), consider the patient's risk to themselves/others.
- Non-pharmacological: Strategies like caregiver training, non-pharmacological interventions (aromatherapy, light therapy, massage). Individualized based on the specific needs, and these interventions must be combined with pharmacological treatments where necessary
- Pharmacological: Use of psychotropic medications like antipsychotics (generally with low effect sizes and potential risks), antidepressants, pain medications, and others. Starting low and gradually increasing dose. Selective serotonin reuptake inhibitors (SSRIs) may be helpful in some cases, but trials often show modest benefit.
- Comfort: Treat pain, constipation, and other forms of discomfort before BPSD-specific interventions.
Differential Diagnosis
- Conditions to rule out: Conditions such as delirium, schizophrenia bipolar disorder, and major depressive disorder, post-traumatic stress disorder, and central nervous system (CNS) neoplasms must be considered when identifying the root cause of the patient's symptoms.
- Overlapping Symptoms: Significant overlap between BPSD or delirium symptoms.
Prognosis and Complications
- Life Expectancy: Dementia correlates with reduced life expectancy compared to healthy controls.
- Progression: BPSD correlates with more rapid progression and earlier mortality.
- Caregiver Burden: Significant impact on caregivers, including increased hospitalizations, complications, earlier placement in nursing homes.
Healthcare Team
- Interprofessional Approach: Important role of nurses, nursing assistants, physical/occupational/recreational therapists, social workers, psychologists, clinical psychologists, pharmacists and physicians in BPSD management. Open communication is key.
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