In DSM-IV-TR the presence or absence of a clinically significant behavioral disturbance can be coded, but no guidance is provided about the diagnostic criteria of these symptoms. The core features of dementia according to DSM-IV-TR and ICD-10 consist of gradual onset of multiple cognitive deficits (involving memory and at least one additional cognitive domain) not occurring exclusively during delirium and representing a decline from a previous level of functioning (American Psychiatric Association, 1994). Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes associated with BPSD.īPSD in the current classification systemsĭespite being almost universally present during the course of dementia, BPSD have not been included in the defining criteria of dementia in the current classification systems. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Recent studies have emphasized the role of neurochemical, neuropathological, and genetic factors underlying the clinical manifestations of BPSD. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social, and biological factors. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis, and treatment response may be useful in the clinical practice. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia.
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