“I Wish You Would Die!” Management of Dementia with BPSD, and Caregiver Stress

@#This is a case of a patient with Behavioural and Psychological Symptoms of Dementia (BPSD) causing caregiver burden in her husband. The family physician was able to lead a multidisciplinary team to manage and optimise her care in the community.

Association between Cognitive Function, Behavioral and Psychological Symptoms of Dementia and White Matter Hyperintensities in Patients with Alzheimer's Disease and Mild Cognitive Impairment / 정신신체의학

OBJECTIVES: The aim of this study is to investigate correlation between degree of white matter hyperintensities (WMH) and neurocognitive function along with behavioral and psychological symptoms of dementia (BPSD) in Korean patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). METHODS: Participants were 115 elderly subjects diagnosed with Alzheimer's disease or mild cognitive impairment in this retrospective study. WMH in brain MRI were rated with standardized visual rating scales (Fazekas scales) and the subjects were divided into two groups according to Fazekas scale. Cognitive function was evaluated with Korean version of the consortium to establish a registry for Alzheimer's Disease (CERAD-K), and BPSD was evaluated with Korean neuropsychiatric inventory (K-NPI). Independent t-test was performed to analyze the relationship between the degree of WMH and neurocognitive functions & BPSD. RESULTS: Especially, the group with high severity of WMH showed significantly lower language fluency (p < 0.05). In addition, the group with high severity of WMH showed significantly higher score in K-NPI. CONCLUSIONS: There was a significant association between WMH and neurocognitive test related with executive function. Moreover, WMH seems to affect BPSD severity. Evaluation of WMH would provide useful information in clinical settings.

“I WISH YOU WOULD JUST DIE!” MANAGEMENT OF DEMENTIA WITH BPSD, AND CAREGIVER STRESS

This is a case of a patient with Behavioural andPsychological Symptoms of Dementia (BPSD) causingcaregiver burden in her husband. The family physician wasable to lead a multidisciplinary team to manage andoptimise her care in the community.

Correlation between Behavioral Psychological Symptoms and Caregiver Burden in Alzheimer's Disease / 정신신체의학

OBJECTIVES: Alzheimer's disease(AD) is characterized by progressive decline of cognitive function and also by various behavioral psychological symptoms of dementia(BPSD) which causes distress to their caregivers. The purpose of this study was to investigate association between each AD patients' behavioral psychological symptoms and their caregivers' burden. METHODS: Participants were 80 AD patients and their caregivers. We used Korean neuropsychiatric inventory (K-NPI) to assess the symptoms of patients and Korean version of Zarit Burden Interview(ZBI) to evaluate caregivers' burden. RESULTS: The results showed ZBI score, which is the index for caregivers' burden, had a statistically significant positive correlation with the frequency of delusion, hallucination, agitation/aggression, depression, anxiety, disinhibition and irritability, the severity of hallucination, agitation/aggression, anxiety, disinhibition, aberrant motor, and sleep, and the global score(frequency×severity) for delusion, hallucination, agitation/aggression, depression, anxiety, disinhibition, aberrant motor, and sleep. There were significant correlations between each scale for cognitive function(i.e. MMSE-KC, CDR, GDS) and ZBI scale. Correlations between each scale for activity of daily living(i.e. Barthel –ADL, K-ADL) and ZBI scale were also significant. CONCLUSIONS: There were a significant correlation between BPSD and caregiver burden. Caregiver burden was also correlated with cognitive function and activity of daily living. Early detection and preventive treatment of these symptoms in BPSD might make improvement of caregivers' quality of life as well as AD patients'.

Neuropsychiatric symptoms in Vascular Cognitive Impairment: A systematic review / Sintomas neuropsiquiátricos no comprometimento cognitivo vascular: revisão sistemática

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]).Objective:To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI).Methods:Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI).Results:A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD.Conclusion:The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]).Objetivo:Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP).Métodos:Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP.Resultados:Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV.Conclusão:O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.

<b>Survey of Psychotropic Drug Usage for Dementia Using a Prescription Database </b> / 薬剤疫学

Guidelines for the usage of psychoactive drugs for behavioral and psychological symptoms of dementia (BPSD) were issued by the Japanese Ministry of Health, Labour and Welfare in July 2013. Using the Anatomical Therapeutic Chemical (ATC) classification with prescription data, we surveyed the usage of psychotropic drugs in patients with dementia. N05C (hypnotics and sedatives) was the most frequently prescribed class of drugs [9,920 (19.7%) individuals]. In addition, there are few prescription ratios of risperidone in comparison with 5.6% and the survey in the UK. Although anti-anxiety drugs should not be used as per BPSD guidelines, etizolam was prescribed in a considerable proportion of patients (6.2%). In addition, with respect to prescription of combinations of antipsychotics in the same month, the highest rate was found for risperidone and tiapride [209 (2.4%) individuals]. In addition, 39 individuals were prescribed antipsychotics that are contraindicated for patients with diabetes. When the number of the clinical departments is as above 2, the ratios to become the contraindicated prescription, careful administration prescription of the antipsychotic increase with significant difference (p<0.01). The increased of the number of the clinical departments tended to increase the ratio of the contraindications and careful administration prescription. Thus, the need for a family doctor to prevent such situations was suggested, which was introduced by the 2014 Medical Treatment Fee Revisions.

Correlation of Behavioral and Psychological Symptoms and Homocysteine in Patients with Dementia of Alzheimer's Type / 정신신체의학

OBJECTIVES: Homocysteine has been associated with cognitive impairment and various psychiatric symptoms. This study was designed to examine the relationship exists between plasma homocysteine concentration and behavioral and psychological symptoms of dementia(BPSD). METHODS: 41 subjects with dementia of Alzheimer's type were included in this study. We carried out history taking, physical examination, and cognitive assessment for the diagnosis of dementia of Alzheimer's type based on DSM-IV. We scored the Mini Mental State Examination(MMSE), Global Deterioration Scale(GDS), Clinical Dementia Rating(CDR), and the Korean Neuropsychiatric Inventory(K-NPI). We also measured levels of homocysteine, folate, and vitamin B12 in the plasma. RESULTS: We found statistically significant positive correlations between homocysteine concentration with NPI total score, and with scores of several sub-domains such as delusion, agitation/aggression, depression/dysphoria, and elation/euphoria. No significant correlation existed between homocysteine levels and scores of MMSE, GDS, and CDR. CONCLUSIONS: This study shows that plasma homocysteine levels are associated with BPSD. Further research is necessary to identify pathophysiologic mechanisms underlying these relationships.

Gender Differences in Behavioral Psychological Symptoms of Dementia in Patients with Alzheimer's Disease / 정신신체의학

OBJECTIVES: Behavioral and psychological symptoms of dementia(BPSD) represent significant clinical problems, resulting in functional decline, caregiver distress, institutionalization and increased mortality. A recent study showed gender differences have important role in the development of BPSD, but relationship between BPSD and gender has never been studied in Korea. This study was designed to examine whether patients with Alzheimer's disease show gender differences in behavioral and psychological symptoms of dementia(BPSD). METHODS: Ninety-eight subjects with Alzheimer's disease were included in this study. We carried out history taking and cognitive assessment for the diagnosis of Alzheimer's disease based on DSM-IV. Cognitive impairment and BPSD were measured using the Mini Mental State Examination(MMSE), Global Deterioration Scale (GDS), Clinical Dementia Rating(CDR) and the Korean Neuropsychiatric Inventory(K-NPI). Independent samples t-test was used to examine the differences across gender in BPSD. Correlation analysis between MMSE, CDR, GDS and NPI was performed using Pearson's correlation coefficient. RESULTS: There were no significant gender differences between the gender in BPSD. We found statistically significant negative correlations between MMSE with NPI total score, and with scores of several sub-domains such as hallucination. CONCLUSIONS: This study showed that gender differences in BPSD are not significant. Further research is necessary to identify whether BPSD affect gender differences or individual differences.

Neurobiology of neuropsychiatric symptoms in Alzheimer?s disease / Neurobiologia dos Sintomas Neuropsiquiátricos na Doença de Alzheimer: Uma revisão crítica com foco na neuroimagem

The objective of this critical review of the literature was to reveal the neural circuits involved in the occurrence of neuropsychiatric symptoms (NPS) in Alzheimer?s disease (AD) patients through the association of these symptoms with neuroimaging findings. The search for articles was performed on PUBMED from January 2000 to May 2013, using thekey words: Dementia AND BPSD; Dementia AND Neuropsychiatric Symptoms; and Dementia AND Psychosis, Delusions, Hallucinations, Agitation, Depression, Anxiety, Apathy, Euphoria, Disinhibition, Irritability, Aberrant Motor Behavior, Sleep or Eating Disorders. Forty-six articles were reviewed and important contributions, especially regarding the psychopathological concepts discussed, were also considered even if not included in this time period. The available evidence suggests thethree most relevant neurobiological models for neuropsychiatric symptoms in Alzheimer?s disease are the frontal-subcortical circuits, the cortico-cortical networks, and the monoaminergic system. We discussed the association of the individual symptoms or syndromes with these models.

O objetivo dessa revisão crítica da literatura é investigar os circuitos neurais envolvidos na ocorrência dos sintomas neuropsiquiátricos nos pacientes com doença de Alzheimer através da associação destes sintomas com achados de neuroimagem. A procura dos artigos foi feita no PUBMED de Janeiro de 2000 a Maio de 2013, usando as palavras chave:Demência E BPSD; Demência E Sintomas Neuropsiquiátricos; e Demência E Psicose, Delírios, Alucinações, Agitação, Depressão, Ansiedade, Apatia, Euforia, Desinibição, Irritabilidade, Comportamento Motor Aberrante, Distúrbios do Sono ou Apetite. Quarenta e seis artigos foram revisados e contribuições importantes, especialmente considerando os conceitospsicopatológicos discutidos, foram também discutidos, mesmo se não incluídos neste período de tempo. As evidências disponíveis sugerem que os três modelos neurobiológicos mais relevantes para os sintomas neuropsiquiátricos na doença de Alzheimer são os circuitos frontal-subcorticais, as redes córtico-corticais, e o sistema monoaminérgico. Nós discutimos a associação dos sintomas individuais ou síndromes com esses modelos.

BPSD following traumatic brain injury / BPSD pós traumatismo cranioencefálico

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. OBJECTIVE: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. METHODS: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. RESULTS: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. CONCLUSION: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

Anualmente, 700 mil pessoas são hospitalizadas com lesão encefálica adquirida após traumatismo cranioencefálico (TCE) no Brasil. OBJETIVO: Nossa meta é revisar os conceitos básicos relacionados ao TCE, e aos Sintomas Comportamentais e Psicológicos da Demência (BPSD) encontrados nos sobreviventes de TCE moderado e grave. Também discutimos as estratégias utilizadas para lidar com os pacientes pós-TCE.MÉTODOS: Quinze pacientes ambulatoriais acompanhados no Centro de Reabilitação Cognitiva pós-traumatismo cranioencefálico do Hospital das Clínicas de São Paulo foram submetidos a avaliações neurológica, neuropsicológica, fonoaudiológica e de terapia ocupacional, incluindo o mini exame do estado mental. Em seguida, estratégias de reabilitação serão desenvolvidas, com a equipe multidisciplinar, para cada paciente individualmente. E, se necessário, a abordagem farmacológica será adotada. RESULTADOS: Nosso estudo irá discutir as opções de escolha de tratamento farmacológico para desordens cognitivas, comportamentais e afetivas pós-TCE, fornecendo informações relevantes relacionadas a um serviço de reabilitação cognitiva estruturada e, certamente, irá oferecer uma alternativa para pacientes e famílias vítimas de TCE. CONCLUSÃO: O traumatismo cranioencefálico pode causar uma variedade de sintomas e síndromes psiquiátricos potencialmente incapacitantes. As estratégias farmacológica e comportamental combinadas para o tratamento de um conjunto de problemas comportamentais muito desafiador parece ser essencial para uma boa recuperação do paciente.

Missing Data Analysis in Drug-Naive Alzheimer's Disease with Behavioral and Psychological Symptoms

PURPOSE: To clarify the effects of missing values due to behavioral and psychological symptoms in dementia (BPSD) in Alzheimer's disease (AD) patients on the neuropsychological tests, this study describes the pattern of missing values due to BPSD, and its influence on tests. MATERIALS AND METHODS: Drug-naive probable AD patients (n=127) with BPSD and without BPSD (n=32) were assessed with Seoul Neuropsychological Screening Battery including measures of memory, intelligence, and executive functioning. Moreover, patients were rated on Korean Neuropsychiatry Inventory (K-NPI). RESULTS: The more severe the K-NPI score, the less neuropsychological tests were assessable, leading to many missing values. Patients with BPSD were more severely demented than those without BPSD. K-NPI scores were significantly correlated with the number of missing values. The effect of BPSD was largest for tests measuring frontal functions. The replacement of the missing values due to BPSD by the lowest observed score also showed the largest effect on tests of frontal function. CONCLUSION: The global cognitive and behavior scales are related with missing values. Among K-NPI sub-domains, delusion, depressing, apathy, and aberrant motor behavior are significantly correlated for missing values. Data imputation of missing values due to BPSD provides a more differentiated picture of cognitive deficits in AD with BPSD.

Association between Characteristics of Brain Magnetic Resonance Imaging and Atypical Antipsychotics Use in Dementia Patients

OBJECTIVES: We aimed to identify the neuroimaging marker for prediction of the use of atypical antipsychotics (AAP) in dementia patients. METHODS: From April 2010 to March 2013, 31 patients who were diagnosed as dementia at the psychiatric department of Soonchunhyang University Hospital, completed the brain magnetic resonance imaging scan and cognitive test for dementia. Ten patients were treated with AAP for the improvement of behavioral and psychological symptoms of dementia (BPSD) and the other 21patients were not. Using T1 weighted and Fluid Attenuated Inversion Recovery (FLAIR) images of brain, areas of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF) and white matter hyperintensities (WMH) have been segmented and measured. Multivariate logistic regression models were applied for assessment of association between AAP use and the GM/WM ratio, the WMH/whole brain (GM + WM + CSF) ratio. RESULTS: There was a significant association between AAP use and the GM/WM ratio (odds ratio, OR = 1.18, 95% confidence interval, CI 1.01-1.38, p = 0.037), while there was no association between AAP use and the WMH/whole brain ratio (OR = 0.82, 95% CI 0.27-2.48, p = 0.73). CONCLUSIONS: The GM/WM ratio could be a biological marker for the prediction of AAP use and BPSD in patients with dementia. It was more likely to increase as dementia progress since atrophy of WM was more prominent than that of GM over aging.

A meta-analysis on the efficacy and safety of risperidone in patients with Behavioral and Psychological Symptoms of Dementia (BPSD)

OBJECTIVE: To determine the efficacy and safety of risperidone compared to placebo and haloperidol in the treatment of behavioral and psychological symptoms of dementia. METHODOLOGY: In a systematic review of literature, all articles published from January 1990 - September 2005 that conducted double-blind, randomized controlled clinical trials evaluating the efficacy and safety of risperidone and haloperidol for the treatment of BPSD were selected. The search was performed by means of MEDLINE, PUBMED, Cochrane Library database limited to studies written in English from 1990 to 2005. Key journals and textbooks were also searched in addition to the electronic database search. References mentioned in these studies were likewise reviewed. Two reviewers independently did validity assessment. Analysis of data was done by statistical packs Revman 4.2.7 from Cochrane Collaboration and SPSS (statistical package for the social sciences) v 9.0. RESULTS: Five trials were included in this study. A total of 964 patients were evaluated. Risperidone was superior to placebo as evidenced by significant reduction in the scores of total BEHAVE-AD score (WMD = 2.97, 95% CI = 1.65 - 4.29), BEHAVE-AD aggression subscale (WMD = 1.40, 95% CI = 1.34 - 1.46), and CMAI total aggression subscale (WMD = 3.82, 95% CI = 3.04 - 4.60). Comparison of risperidone and haloperidol showed significant reduction in the total BEHAVE- AD score in patients receiving risperidone (WMD = 1.80, 95% CI = 0.43 - 3.18). Comparing the odds ratio of having an adverse effect, analysis revealed greater chance of developing somnolence (OR = 1.88, 95% CI = 1.27 - 2.77), peripheral edema (OR = 2.43, 95% CI = 1.29 - 4.59) and extrapyramidal symptoms (OR = 1.93, 95% CI = 1.04 - 3.61) with risperidone. CONCLUSION: Risperidone is effective and relatively safe in the treatment of behavioral and psychological symptoms of dementia. Higher incidence of somnolence, peripheral edema and extrapyramidal symptoms was noted with risperidone compared to placebo. Compared with haloperidol, risperidone was superior in the total BEHAVE- AD scale and showed more favorable results in the total CMAI scale, BEHAVE-AD aggression and CMAI total aggression subscales.

Hypersexuality in dementia: a case report

This case report highlights the issue of hypersexuality in persons with dementia and outlines the possible etiology and challenges associated with interventions of inappropriate sexual behaviors in dementia. Methods: We report a 75-year-old male with vascular dementia who developed hypersexuality and aggression towards his wife. The management plans are elaborated in this paper. Results: A combination of pharmacological and psychosocial intervention lead to the resolution of his inappropriate sexual behavior and improvement in his relationships with his wife and children. Conclusion: Inappropriate sexual behaviors need to be recognized and managed without compromising the fulfillment of the human’s basic need of sexuality.

Voxel-based morphometry findings in Alzheimer's disease: neuropsychiatric symptoms and disability correlations - preliminary results

INTRODUCTION: The role of structural brain changes and their correlations with neuropsychiatric symptoms and disability in Alzheimer's disease are still poorly understood. OBJECTIVE: To establish whether structural changes in grey matter volume in patients with mild Alzheimer's disease are associated with neuropsychiatric symptoms and disability METHODS: Nineteen Alzheimer's disease patients (9 females; total mean age =75.2 y old +4.7; total mean education level =8.5 y +4.9) underwent a magnetic resonance imaging (MRI) examination and voxel-based morphometry analysis. T1-weighted images were spatially normalized and segmented. Grey matter images were smoothed and analyzed using a multiple regression design. The results were corrected for multiple comparisons. The Neuropsychiatric Inventory was used to evaluate the neuropsychiatric symptoms, and the Functional Activities Questionnaire and Disability Assessment for Dementia were used for functional evaluation RESULTS: A significant negative correlation was found between the bilateral middle frontal gyri, left inferior temporal gyrus, right orbitofrontal gyrus, and Neuropsychiatric Inventory scores. A negative correlation was found between bilateral middle temporal gyri, left hippocampus, bilateral fusiform gyri, and the Functional Activities Questionnaire. There was a positive correlation between the right amygdala, bilateral fusiform gyri, right anterior insula, left inferior and middle temporal gyri, right superior temporal gyrus, and Disability Assessment for Dementia scores CONCLUSIONS: The results suggest that the neuropsychiatric symptoms observed in Alzheimer's disease patients could be mainly due to frontal structural abnormalities, whereas disability could be associated with reductions in temporal structures.

Investigation in behavioral and psychological symptoms of senile dementia patients and nursing inter-vention / 中国实用护理杂志

Objective To investigate the behavioral and psychological symptoms of serfi[e dementia pa-tents and nursing intervention. Methods 56 senile dementia patients were investigated and analyzed about their behavioral and psychological symptoms, nursing interventions were given to them accord-ingly. Results The incidence rate of behavioral and psychological symptoms of dementia (BPSD) was 94.64%. Diet and psychological care was given according to its behavioral and psychological symptoms, and symptomatic nursing was strengthened and measures were taken to prevent and treat somatic disease. sions Strengthening the nursing quality of senile dementia patients has important significance in improving their quality of life, and reducing the burden of caregivers.

Diagnosis and Treatment for Behavioral and Psychological Symptoms of Dementia

Dementia is a common neuropsychiatric disorder characterized by progressive impairment of cognitive abilities and distinct behavioral and psychological symptoms. In particular, various behavioral and psychological symptoms of dementia (BPSD) add to the burden of family and society. Moreover, the number of dementia patients is rapidly growing with increasing elderly population. The main symptoms of BPSD are anxiety, depression, delusions and hallucinations. BPSD produce significant problems for both patients and caregivers. Aggravated BPSD accelerates impairment of cognitive function and induces early nursing home placement, increasing cost for care while decreasing quality of life. The pathophysiology of BPSD is determined by genetic, structural, or environmental factors. Diagnosis of BPSD used "NPI, BEHAVE-AD and BRSD of CERAD". The management of BPSD requires both pharmacological and non-pharmacological treatment. When BPSD are mild, non-pharmacological strategies are essential, but for patients with moderate to severe BPSD, pharmacological intervention should also be emphasized.

Five Cases of Alzheimer's Type Dementia Showing Behavioral and Psychological Symptoms of Dementia (BPSD) Successfully Treated with Yokukansan / 日本東洋医学雑誌

We described here five patients with Alzheimer's disease (AD) who have behavioral and psychological symptoms of dementia (BPSD), and who have shown a remarkable improvement as a result of Yokukansan treatment. All five patients exhibited irritability and excitement, four of the patients suffered from aggression and insomnia, and three suffered from wanderings. All of the patients started recovering from these symptoms within 1-2 weeks from the start of the treatment, without any adverse reaction. In conclusion, our case study suggests that Yokukansan is a safe and effective treatment for AD patients with BPSD. Our study further suggests that Yokukansan is especially useful for patients who are difficult to treat with neuroleptics, such as patients with insomnia and wandering, patients exhibiting a depressive state as well as irritability and excitement, and those with physical symptoms, including gait disturbances and urinary incontinence.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.

Characteristics of Behavioral and Psychological Symptoms by Dementia Stage: Evaluated by the Korean Version of Neuropsychiatric Inventory / 신경정신의학

OBJECTIVES: This study aimed to compare the behavioral psychological symptoms of dementia by stages and to suggest the proper management treatment plan. METHODS: We examined behaviral psychological symptoms in 17 dementia patients with mild stage (CDR=0.5, 1), 18 dementia patients with moderate stage (CDR=2) and 24 dementia patients with severe stage (CDR=3, 4). We compared the prevalence and the composite scores (frequency X severity) of each behavioral domain in K-NPI among three groups. The MMSE-K, GDS, Barthel ADL were also administrated to evaluate the general cognitive function, severity of the patients and activity of daily living. RESULTS: The most common behavioral disturbances were apathy/indifference, depression/dysphoria, and aberrant motor behavior. The mean composite score of aberrant motor behavior increased by stages of dementia severity with statistical significance. The total score of the K-NPI increased with severer stages of dementia the result didn't show statistical significance. The K-NPI score showed the positive correlation with CDR, GDS and the negative correlation with MMSE-K, B-ADL. But, there was no statistically significant correlation. CONCLUSION: Behavioral and Psychological Symptoms of Dementia (BPSD) change by the stages of dementia. The practical guideline for BPSD management according to dementia stage is needed. Re-evaluation and new therapeutic inter-vention must be considered by the stages of dementia.