Behavioral Symptoms of Dementia in Geriatric Patients

 
Geriatrics Case Conference
 
December 3rd, 2020
 
 
Thomas Magnuson, MD
 
Behavioral and Psychological
Symptoms of Dementia
 
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.
 
Behavioral and
Psychological
Symptoms of Dementia
 
Thomas Magnuson, M.D.
Associate Professor
Division of geriatric  of Psychiatry
UNMC
 
Dementia Symptoms
 
Primary dementia symptoms
Memory loss
In many cases the presenting symptom
Plus other symptoms
Communication problems
Failure of the senses
Motor difficulties
Executive errors
Changed personality
 
Behavioral and Psychological Symptoms of
Dementia (BPSD)
 
Secondary symptoms
Depression
Psychosis
Aggression/Agitation
Disruptive vocalizations
Anxiety
Apathy
Night-time behaviors
Hypersexuality
 
Behavioral Problems
 
Pervasive
80-90% of all dementia patients will have at least one
behavioral problem
Agitation 25-87%
Restlessness  40-60%
Aggression 11-46%
Positive correlation
severity of dementia and behavioral problems
13.8-37.5% mild
62.5-66.5% severe
 
Behavioral Problems
 
Agitation
Wandering
18-50%
Hypersexuality
2-7%
Disruptive vocalizations
11-47%
Hoarding, stealing
15-22%
Disrupted sleep cycle
25-35%
Resistance to daily cares
13%
 
Behavioral Problems
 
Often lead to placement
Nearly 60% of demented patients at home have at least
one behavioral symptom
The prevalence of behavioral symptoms increases as the
patient’s cognitive impairment worsens
Direct link between level of cognition and nursing home
placement
Dementia-related behaviors as predictor
Usually cited as a leading reason for admission
46% in Buhr GT, et al. (2006)
 
Behavioral Problems
 
A variety of etiologies
Medical
Acute onset
UTI, hyponatremia, pneumonia, fracture
Chronic changes
CHF, COPD, pain from arthritis
Pharmacologic/Substance
Anticholinergic medications
Corticosteroids
Alcohol
Psychiatric
Depression, anxiety and psychosis
Due to dementia
 
Psychiatric
 
Mood
Depression, hypomania, mania
25-50% of patients with dementia will develop
depression from the dementia
50% of Nursing Home residents have depression
Much, but not all is from dementia
Anxiety
Generalized to more specific presentations
29-44% of demented patients will have anxiety
Psychosis
Hallucinations and delusions
20-50% prevalence
 
Basic Approach
 
Information gathering
History
No one became borderline at 75 years old
Paramount
Didn’t your mother ask what you did to make your brother sock you?
Human nature to think it was not caused by anything I did
Data
MAR, nursing notes, behavioral sheets
Context of the problem
The reporter’s questions
“who, what, when…
Just calling on this shift
Call back and ask the evening shift
They must be very specific
“All the time” means we don’t know
Dysfunctional or distressing
Non bothersome hallucinations are not treated
Neither are life-affirming delusions
Not dysfunctional for the nursing staff
Having trouble with toileting is an educational issue
 
Basic Approach
 
Be wary of suggestions on faxes
By people who are well-meaning, but uniformed
“Seroquel 50 mg a day. Yes or No?”
Inpatient psychiatry
Vacation for the staff
Threats to families of eviction
Look a lot different in the ED
Once they get there they do not have to take them back…
Defer dementia patients
Placement issue
Be wary of small town hospitals
Return on mucho meds
Stay until their insurance runs out
Low-hanging fruit from a reimbursement standpoint
 
Basic Approach
 
Nonpharmacologic
Have resources available to pass on to the staff
Multiple sources these days
https://www.unmc.edu/intmed/divisions/geriatrics/education/resources/dementia.html
Need a nonpharmacologic treatment plan
Pharmacologic
Know what your target symptoms are
Not much definitive information that anything works
Safety issues abound
Medication has a place
Constant reassessment for tolerance, safety, efficacy
Start low, Go slow
 
Basic Approach
 
At home
Caregiver burden
Resources to aid lessen burden
Who is the actual patient?
Capacity of the caregiver
Formal and non-formal network of services
When to move the patient
Relieve the family of guilt
This is a MEDICAL decision
Prevent more rapid deterioration
Where to move the patient
Don’t be fooled by furniture
Wallet biopsy
Ambulatory, younger, aggressive demented males
 
Have specific questions?
 
Curbside
You are paying my salary
Discuss options, care plan
tmagnuson@unmc.edu
402-552-6007
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This informational content discusses the various behavioral and psychological symptoms of dementia (BPSD) in geriatric patients, including common symptoms like depression, aggression, anxiety, and apathy. It highlights the prevalence of behavioral issues in dementia patients, their impact on caregiving and nursing home placements, and the correlation between severity of dementia and behavioral problems. The material provides insights into the challenges faced by individuals dealing with dementia-related behaviors and the importance of understanding and managing these symptoms effectively.


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  1. Geriatrics Case Conference Behavioral and Psychological Symptoms of Dementia Thomas Magnuson, MD December 3rd, 2020

  2. This program is supported by the This program is supported by the Health Resources and Services Health Resources and Services Administration (HRSA) Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling 751,695.00 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

  3. Behavioral and Psychological Symptoms of Dementia Thomas Magnuson, M.D. Associate Professor Division of geriatric of Psychiatry UNMC

  4. Dementia Symptoms Primary dementia symptoms Memory loss In many cases the presenting symptom Plus other symptoms Communication problems Failure of the senses Motor difficulties Executive errors Changed personality

  5. Behavioral and Psychological Symptoms of Dementia (BPSD) Secondary symptoms Depression Psychosis Aggression/Agitation Disruptive vocalizations Anxiety Apathy Night-time behaviors Hypersexuality

  6. Behavioral Problems Pervasive 80-90% of all dementia patients will have at least one behavioral problem Agitation 25-87% Restlessness 40-60% Aggression 11-46% Positive correlation severity of dementia and behavioral problems 13.8-37.5% mild 62.5-66.5% severe

  7. Behavioral Problems Agitation Wandering 18-50% Hypersexuality 2-7% Disruptive vocalizations 11-47% Hoarding, stealing 15-22% Disrupted sleep cycle 25-35% Resistance to daily cares 13%

  8. Behavioral Problems Often lead to placement Nearly 60% of demented patients at home have at least one behavioral symptom The prevalence of behavioral symptoms increases as the patient s cognitive impairment worsens Direct link between level of cognition and nursing home placement Dementia-related behaviors as predictor Usually cited as a leading reason for admission 46% in Buhr GT, et al. (2006)

  9. Behavioral Problems A variety of etiologies Medical Acute onset UTI, hyponatremia, pneumonia, fracture Chronic changes CHF, COPD, pain from arthritis Pharmacologic/Substance Anticholinergic medications Corticosteroids Alcohol Psychiatric Depression, anxiety and psychosis Due to dementia

  10. Psychiatric Mood Depression, hypomania, mania 25-50% of patients with dementia will develop depression from the dementia 50% of Nursing Home residents have depression Much, but not all is from dementia Anxiety Generalized to more specific presentations 29-44% of demented patients will have anxiety Psychosis Hallucinations and delusions 20-50% prevalence

  11. Basic Approach Information gathering History Paramount No one became borderline at 75 years old Didn t your mother ask what you did to make your brother sock you? Human nature to think it was not caused by anything I did Data MAR, nursing notes, behavioral sheets Context of the problem The reporter s questions who, what, when Just calling on this shift Call back and ask the evening shift They must be very specific All the time means we don t know Dysfunctional or distressing Non bothersome hallucinations are not treated Neither are life-affirming delusions Not dysfunctional for the nursing staff Having trouble with toileting is an educational issue

  12. Basic Approach Be wary of suggestions on faxes By people who are well-meaning, but uniformed Seroquel 50 mg a day. Yes or No? Inpatient psychiatry Vacation for the staff Threats to families of eviction Look a lot different in the ED Once they get there they do not have to take them back Defer dementia patients Placement issue Be wary of small town hospitals Return on mucho meds Stay until their insurance runs out Low-hanging fruit from a reimbursement standpoint

  13. Basic Approach Nonpharmacologic Have resources available to pass on to the staff Multiple sources these days https://www.unmc.edu/intmed/divisions/geriatrics/education/resources/dementia.html Need a nonpharmacologic treatment plan Pharmacologic Know what your target symptoms are Not much definitive information that anything works Safety issues abound Medication has a place Constant reassessment for tolerance, safety, efficacy Start low, Go slow

  14. Basic Approach At home Caregiver burden Resources to aid lessen burden Who is the actual patient? Capacity of the caregiver Formal and non-formal network of services When to move the patient Relieve the family of guilt This is a MEDICAL decision Prevent more rapid deterioration Where to move the patient Don t be fooled by furniture Wallet biopsy Ambulatory, younger, aggressive demented males

  15. Have specific questions? Curbside You are paying my salary Discuss options, care plan tmagnuson@unmc.edu 402-552-6007

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