BACKGROUND: Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient. METHODS: This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia." RESULTS: Behavioral disorders regularly accompany dementing illness and have identifiable and treatable somatic and environment-related causes. They should be treated symptomatically, both with non-pharmacological measures and with drugs. Memory therapy (d = 0.47), ergotherapy (d = 0.72), music therapy (d = 0.62), and physical exercise (d = 0.68) are effective, as are antidementia drugs (galantamine: p = 0.04, donepezil: p = 0.01, rivastigmine: p = 0.02, memantine: p = 0.004). Risperidone is the drug of choice to combat agitation and aggressiveness (d = 0.33) as well as dementia and hallucinations (d = 0.5). Citalopram can be recommended for the treatment of depression in patients with dementia (p = 0.05). CONCLUSION: Because of an improved evidence base, the latest version of the German S3 guideline on the diagnosis and treatment of dementia places greater emphasis on non-pharmacological treatments for behavioral disorders in dementia than it did in the past. The global efficacy of such treatments against behavioral disorders is well documented. Nonetheless, because of the heterogeneity of interventions and varying standards of assessment, the evidence for the utility of certain specific methods in the treatment of specific behavioral disorders is still limited. More research is needed in this area.
BACKGROUND:Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient. METHODS: This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia." RESULTS:Behavioral disorders regularly accompany dementing illness and have identifiable and treatable somatic and environment-related causes. They should be treated symptomatically, both with non-pharmacological measures and with drugs. Memory therapy (d = 0.47), ergotherapy (d = 0.72), music therapy (d = 0.62), and physical exercise (d = 0.68) are effective, as are antidementia drugs (galantamine: p = 0.04, donepezil: p = 0.01, rivastigmine: p = 0.02, memantine: p = 0.004). Risperidone is the drug of choice to combat agitation and aggressiveness (d = 0.33) as well as dementia and hallucinations (d = 0.5). Citalopram can be recommended for the treatment of depression in patients with dementia (p = 0.05). CONCLUSION: Because of an improved evidence base, the latest version of the German S3 guideline on the diagnosis and treatment of dementia places greater emphasis on non-pharmacological treatments for behavioral disorders in dementia than it did in the past. The global efficacy of such treatments against behavioral disorders is well documented. Nonetheless, because of the heterogeneity of interventions and varying standards of assessment, the evidence for the utility of certain specific methods in the treatment of specific behavioral disorders is still limited. More research is needed in this area.
Authors: Cheryl L P Vigen; Wendy J Mack; Richard S E Keefe; Mary Sano; David L Sultzer; T Scott Stroup; Karen S Dagerman; John K Hsiao; Barry D Lebowitz; Constantine G Lyketsos; Pierre N Tariot; Ling Zheng; Lon S Schneider Journal: Am J Psychiatry Date: 2011-05-15 Impact factor: 18.112
Authors: A L Nyth; C G Gottfries; K Lyby; L Smedegaard-Andersen; J Gylding-Sabroe; M Kristensen; H E Refsum; E Ofsti; S Eriksson; S Syversen Journal: Acta Psychiatr Scand Date: 1992-08 Impact factor: 6.392
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Authors: J Diehl-Schmid; L Riedl; U Rüsing; J Hartmann; M Bertok; C Levin; J Hamann; M Arcand; S Lorenzl; B Feddersen; R J Jox Journal: Nervenarzt Date: 2018-05 Impact factor: 1.214
Authors: Mairead M Bartley; Laura Suarez; Reem M A Shafi; Joshua M Baruth; Amanda J M Benarroch; Maria I Lapid Journal: Curr Psychiatry Rep Date: 2018-06-23 Impact factor: 5.285
Authors: Marion Ortner; Marion Stange; Heike Schneider; Charlotte Schroeder; Katharina Buerger; Claudia Müller; Bianca Dorn; Oliver Goldhardt; Janine Diehl-Schmid; Hans Förstl; Werner Steimer; Timo Grimmer Journal: Front Pharmacol Date: 2020-05-21 Impact factor: 5.810