Editorial: management of behavioral and psychiatric symptoms in dementia.
Dementia is an increasingly prominent problem in clinical practice given the growth of elderly populations in the past twenty five years. While dementia is not limited to the elderly, it is by far the group which suffers most from dementia. Indeed, Alzheimer's disease, Lewy body dementia, and vascular dementia, which account for more than three-fourths of all dementias, are almost entirely diseases of advanced age. Given the predicted accelerated growth of aged populations in the coming decades in most industrialized countries, dementia will pose an increasing burden of care on treating physicians and dementia caregivers. The hallmark of any dementia is its accompanying loss of intellect and decline of varying cognitive abilities. Perhaps the most clinically prominent aspect of cognitive decline is memory loss. This is probably because memory impairment tends to occur early in the evolution of symptoms and because it is socially prominent and relatively easy to measure during clinical consultation. At the time of an early diagnosis, memory loss, and at least one other cognitive impairment such as language difficulty, visual-spatial or executive dysfunctions are present. These impairments already have had some impact in the patient's ability to function normally on a daily basis if the diagnosis of dementia is made.Diminishment of cognitive ability, however, is not the only important symptomatology present in dementia. Behavioral and psychiatric symptoms are also prominent clinical features of this syndrome, whatever the underlying cause may be. These symptoms may not be obvious during the early stages of dementia of the Alzheimer type, but may be more in evidence during this initial period, and thereafter, in the fronto-temporal and in Lewy body dementias. During the evolution of most progressive dementia syndromes, the appearance of behavioral and psychiatric complications such as agitation, aggression, contrariness and psychosis constitute a major management problem for treating physicians and patient caregivers. The appearance of behavioral and psychiatric symptoms constitutes a serious management challenge for physicians and caregivers alike. The evolution of these symptoms result in the major reason for caregiver "burnout" and patient institutionalization, with an enormous increase in medical and indirect costs, and with a frequent decrease in quality of life for the patient. While modestly effective interventions to attenuate the negative impact of behavioral and psychiatric symptoms, no incontrovertible scientific approach exists. The literature supports the implementation of particular non-pharmacologic interventions as part of a broader plan of management, but it remains evident that in most cases pharmacological intervention will be needed at some point in the evolution of the illness. The available literature today includes only a relatively small number of well controlled, randomized studies that examine pharmacologic interventions to manage behavioral and psychiatric in elderly patients with dementia. These studies do not yield clearly definitive results on the best, or clearly superior approaches, while other studies have noted the potential serious side-effects of some of the same pharmacologic agents, including somewhat higher mortality rates in treated dementia populations.Thus, in the absence of established, clearly definitive treatments for behavioral and psychiatric complications of dementia, a combination of partial scientific clinical results and varying clinical pragmatism and experience informs management. In order to bring more coherence to approaches the management of these universally troubling complications, a group of international clinical experts in dementia, convened this year in Nice and then in Paris in an attempt to find a general consensus of recommended behavioral and psychiatric interventions in dementia. Not all behavioral complications were reviewed. The focus centered only on active behaviors such as agitation, aggression, psychosis and contrariness. The following document (1), whose non-unanimous results reflect the difficulty of that undertaking and the need for further research in the field, bear the fruit of those meetings. It is hoped that the reviews of the literature conducted to inform those discussions and debates and the commentaries accompanying the degrees of consensus achieved on each topic are of value to the reader.Reference. 1. Benoit M., Arbus C., Blanchard F. et al. Professional Consensus on the Treatment of Agitation, Aggressive Behaviour, Oppositional Behaviour and Psychotic Disturbances in Dementia, Jour Nutr Health and Aging, vol 10, n degrees 5, 410-415.[1]References
- Editorial: management of behavioral and psychiatric symptoms in dementia. Fitten, L.J. The journal of nutrition, health & aging. (2006) [Pubmed]
Annotations and hyperlinks in this abstract are from individual authors of WikiGenes or automatically generated by the WikiGenes Data Mining Engine. The abstract is from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.About WikiGenesOpen Access LicencePrivacy PolicyTerms of Useapsburg
