Neuropsychiatric Symptoms of Dementia PDF

**[Neuropsychiatric Symptoms of Dementia]** **Neuropsychiatric Symptoms** - [Behavioural and Psychological Symptoms of Dementia (BPSD]): disturbed perception, thought, mood, or behaviour symptoms of dementia. - They may come separately or clustered. - Cluster analyses most...

**[Neuropsychiatric Symptoms of Dementia]** **Neuropsychiatric Symptoms** - [Behavioural and Psychological Symptoms of Dementia (BPSD]): disturbed perception, thought, mood, or behaviour symptoms of dementia. - They may come separately or clustered. - Cluster analyses most commonly define subgroups of -- agitation, psychosis and mood disorder. **The Neuropsychiatric Inventory (NPI)** - Semi-structured instrument administered to the caregiver. - 12 domains - Each symptom is rated by frequency and severity or as absent and the overall severity score is their product. **Mild Cognitive Impairment (MCI)** - Significant neuropsychiatric symptoms in 25% with MCI. - 75% persistent at 6 months. - Persistent symptoms (delusions, agitation, apathy, sadness) were more severe at baseline. **Pre-cognitive Impairment** - New neuropsychiatric symptoms in older people without cognitive impairment may be pre-dementia. - New onset agitation has highest odds ration of becoming MCI over 5 years. - NPS pre-dementia associated with tau and amyloid neuropathology. - Underlying neurobiological mechanisms might underpin symptoms. Neurodegeneration leads to an increased vulnerability to stressors or triggers. - Genetics, personal history, comorbidities, environment, and carer response. **Prevalence of NPS in Dementia** - 75% with AD have one or more clinically significant symptom, 80% have persistent significant symptoms at 6 months. - Apathy, aberrant motor behaviour, and agitation are the most common. - Persistence predicted by severity at baseline. - Apathy, agitation, and delusions are the most persistent. - NPS deterioration predicted by MMSE deterioration. - [In nursing homes]: over 90% of patients have one or more clinically significant NPS and they tend to be more persistent. **Psychosis in Dementia** - Prevalence about 18% cross sectionally. - Prevalence increasing from mild to moderate dementia and then flattens out. - Psychotic symptoms tend to persist in most people for at least some months. - [Symptoms]: - Delusions are the most common and are usually simple. - Theft, abandonment, poisoning, misidentification. - Hallucinations usually consist of visual, but some are auditory (sounds, individual words or phrases). - Well-formed visual hallucinations are particularly prominent in DLB and less common in FTD. - **Not psychosis in dementia** - Charles Bonnet Syndrome (CBS): complex persistent visual hallucinations in the absence of a mental disorder in visually impaired. **Depression in Dementia** - Depression occurs in at least 20% of people with AD and more in VD. - No good evidence that medication and exercise and psychotherapy by themselves work. **Interventions that have Worked:** - [While NPS are happening]: activities, music therapy, sensory interventions. - [Over months]: supervised person-centred care, supervised communication skills, and dementia mapping with supervision. - [Tailored Activity Program (TAP)]: carers trained to use activities tailored to interests and abilities of people with dementia, disease education and stress reduction techniques. **Interventions that DO NOT Work:** - Light therapy - Aromatherapy - Training family carers in behavioural and cognitive interventions **Sleep Disturbances in Dementia:** - Common in dementia (39% in AD; higher in DLB). - [Includes]: impaired sleep initiation, reduced night-time sleep, night-time wandering, daytime sleep, behavioural changes at night. - Suprachiasmatic nucleus degeneration causes disruption in the normal circadian rhythm, inactivity/ napping can impact sleep pressure, other physical illnesses, environmental factors, and anxiety are all reasons for sleep problems.