Prevalence and Management of Behavioural and Psychiatric Symptoms on a Continuing Care Unit for Patients with Dementia

Abstract

Objectives:

With the increasing concerns over the safety of some pharmacological interventions or lack of sufficient evidence of effectiveness in managing neuropsychiatric symptoms in dementia, there is a constant need to review how such patients are managed. This study looks at the prevalence and management of behavioural and psychiatric symptoms amongst patients with dementia in a National Health Service (NHS) continuing care unit.

Method:

In this study, a survey of all 50 patients admitted to a longstay NHS-funded dementia care unit was carried out. The socio-demographic details along with severity of dementia, neuropsychiatric symptoms, and medication were obtained on all the patients.

Findings:

All 50 patients were prescribed some form of medication for either physical and/or mental health reasons. Only five (10%) patients were not prescribed any form of psychotropic medication. A lack of non-pharmacological treatment options for the treatment of neuropsychiatric symptoms was evident in the unit with only one occupational therapist available.

Conclusion:

Effective management of severe behavioural and psychiatric symptoms in dementia is challenging even in a NHS continuing care dementia unit due to the absence of clear benefit from pharmacological interventions and lack of resources for optimum non-pharmacological interventions.

Keywords

neuropsychiatric symptoms dementia long-stay care continuing care

Get full access to this article

View all access options for this article.

References

Sarazin

Horne

Dubois

. Natural decline and prognostic factors. In Gauther

, (Ed.), Clinical diagnosis and management of Alzheimer's disease (3rd Edition, Chapter 11). Informa Healthcare, 2006; 137–148.

Ballard

Margallo-Lana

Fossey

Reichelt

Myint

Potkins

O'Brien

. A 1 year follow-up study of behavioural and psychological symptoms in dementia among people in care environments. Journal of Clinical Psychiatry 2001; 62: 8.

Sawa

Zaccai

Matthews

Davidson

McKeith

Brayne

. Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry 2009; 194: 212–219.

Eustace

Cohen

Walsh

Cunningham

Walsh

Coakley

Lawlor

. A longitudinal evaluation of behavioural and psychological symptoms of probable Alzheimer's disease. International Journal of Geriatric Psychiatry 2002; 17: 968–973.

Wancata

Benda

Meise

Windharber

. Non-cognitive symptoms of dementia in nursing homes: Frequency, course and consequences. Social Psychiatry and Psychiatric Epidemiology 2003; 38: 637–643.

Shin

Carter

Masterman

Fairbanks

Cummings

. Neuropsychiatric symptoms and quality of life in Alzheimer's disease. American Journal of Psychiatry 2005; 13: 469–474.

Aalten

De Vugt

Jaspers

Jellemer

Jolles

Verhey

FRJ

. The course of neuropsychiatric symptoms in dementia. Part I: Findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry 2005; 20: 523–530.

Wood

Cummings

Barclay

Hsu

M-A

Allahyar

Schnelle

. Assessing the impact of neuropsychiatric symptoms on distress in professional caregivers. Aging & Mental Health 1999; 3(3): 241–245.

LoGiudice

Waltrowicz

McKenzie

Ames

Flicker

. Prevalence of dementia among patients referred to an aged care assessment team and associated stress in their carers. Australian Journal of Public Health 1995; 19(3): 275–279.

10.

Beeri

Werner

Davidson

Noy

. The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer's disease patients. International Journal of Geriatric Psychiatry 2002; 17: 403–408.

11.

Sink

Holden

Yaffe

. Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. Journal of the American Medical Association 2005; 293(5): 596–608.

12.

Koopmans

van der Molen

Rats

Ettema

. Neuropsychiatric symptoms and quality of life in patients in the final phase of dementia. International Journal of Geriatric Psychiatry 2009; 24: 25–32.

13.

NICE Clinical Guidelines CD42. Dementia: Supporting people with dementia and their carers in health and social care. November 2006.

14.

McKeith

; Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium. Neurology 2005; 65: 1863–1872.

15.

Cummings

Mega

Gray

Rosenberg-Thompson

Carusi

Gornbein

. The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308–2314.

16.

Wood

Cummings

Hsu

The use of the Neuropsychiatric Inventory in nursing home residents: Characterization and measurement. American Journal of Geriatric Psychiatry 2000; 8: 75–83.

17.

Margallo

Swann

O'Brien

Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in a care environment. International Journal of Geriatric Psychiatric 2001; 16: 39–44.

18.

Hughes

Berg

Danziger

Coben

Martin

. A new clinical scale for the staging of dementia. British Journal of Psychiatry 1982; 140: 566–572.

19.

Morris

. The CDR: Current version and scoring rules. Neurology 1993; 43: 2412–2413.

20.

Folstein

McHughes

. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 1975; 12: 189–198.

21.

De Vugt

Riedijk

Aalten

Tibben

Van Swieten

Verhey

FRJ

. Impact of behavioural problems on spousal caregivers: A comparison between Alzheimer's disease and frontotemporal dementia. Dementia and Geriatric Cognitive Disorders 2006; 22: 35–41

22.

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_108303.

23.

Schneider

Tariot

Dagerman

Davis

Hsiao

Ismail

Lebowitz

Lyketsos

Ryan

Stroup

Sultzer

Weintraub

Lieberman

. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine 2006; 355(15): 1525–1538.

24.

Bains

Birks

Dening

. Antidepressants for treating depression in dementia. Cochrane Database of Systemic Reviews 2002, Issue 4. Art. No. CD003944 DOI:10.1002/14651858.CD003944.

25.

Aupperle

. Management of aggression, agitation and psychosis in dementia: Focus on atypical antipsychotics. American Journal of Alzheimer's Disease and Other Dementias 2006; 21(2): 101–108.

26.

Ruths

Strand

Nygaard

Aarsland

. Stopping antipsychotics drug therapy in demented nursing home patients: A randomised, placebo-controlled study—The Bergen District Nursing Home Study (BEDNURS). International Journal of Geriatric Psychiatry 2008; 23: 889–895.

27.

Bridges-Parlet

Knopman

Steffes

. Withdrawal of neuroleptic medications from institutionalised dementia patients: Results of a double blind, baseline-treatment-controlled pilot study. Journal of Geriatric Psychiatry & Neurology 1997; 10: 119–126.

28.

Cohen-Mansfield

Lipson

Werner

Withdrawal of haloperidol, thioridazine, and lorazepam in the nursing home: A controlled, double blind study. Archives of Internal Medicine 1999; 159: 1733–1740.

29.

Ballard

Thomas

Fossey

A 3-month, randomized, controlled neuroleptic discontinuation study in 100 people with dementia: The neuropsychiatric inventory median cuff is a predictor of clinical outcome. Journal of Clinical Psychiatry 2004; 65: 114–119.

30.

Feldman

Gauthier

Hecker

A 24-week, randomised, double-blind study of Donepezil in moderate to severe Alzheimer's disease. Neurology 2001; 57: 613–620.

31.

Fauthier

Lilienfeld

. Galantamine improves function and behaviours in Alzheimer's disease with cerebrovascular components and in probable vascular dementia. International Psychogeriatrics 2001; 13(Suppl 2): 232 (Abstr P228).

32.

Cummings

Ananad

Koumaras

Rivastigmine provides behavioural benefits to Alzheimer's disease patients residing in a nursing home: Findings from a 26–week trail. Neurology 2000; 54(Suppl 3): A468 (Abstr S79.002).

33.

Maidment

. Efficacy of Memantine on behavioural and psychological symptoms related to dementia: A systematic meta-analysis. The Annals of Pharmacotherapy 42(1): 32–38.

34.

Ayalan

Gum

Feliciano

Arean

. Effectiveness of non-pharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia. Archives of Internal Medicine 2006; 166: 2182–2188.

35.

Ledger

Baker

. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer's disease. Ageing & Mental Health 2007; 11(3): 330–338

36.

Opie

Roewarne

O'Connor

. The efficacy of psychosocial approaches to behaviour disorders in dementia: A systematic literature review. Australia and New Zealand Journal of Psychiatry 1999; 33(6): 789–799.