Behavioral And Psychological Symptoms Of Dementia

The decision, which constitute acts of a behavior-related symptom is very subjective. Tolerability (which behavior can tolerate the caregivers?) Depends in part on the living conditions of the patients, especially the security decreases. can wander around for. B. be tolerated if a patient lives in a safe environment (with locks and alarm fuse on all doors and outputs); However, if the patient lives in a nursing home or hospital that wandering can be unbearable, because it interferes with other patients or the operation of the institution.

Disruptive behaviors are common in patients with dementia and the most important reason for 50% of the shots in a nursing home. Disruptive behavior includes wandering, restlessness, crying, throwing, hitting, denial of treatments, endless questions, interrupting the work of nurses, insomnia and wines. Behavioral and psychological symptoms of dementia are not well characterized, and their treatment is poorly understood. The decision, which constitute acts of a behavior-related symptom is very subjective. Tolerability (which behavior can tolerate the caregivers?) Depends in part on the living conditions of the patients, especially the security decreases. can wander around for. B. be tolerated if a patient lives in a safe environment (with locks and alarm fuse on all doors and outputs); However, if the patient lives in a nursing home or hospital that wandering can be unbearable, because it interferes with other patients or the operation of the institution. Many behaviors (eg. As wandering, repeated questions, uncooperative behavior) during the day to endure better. Whether the Sundowning phenomenon (increase in disruptive behavior at sunset and early evening) represents a decreasing tolerance of nurses or a real daily variation is unknown. In nursing homes, 12-14% of patients with dementia show evening more disruptive behavior than during the day. Etiology Behavioral and psychological symptoms may be caused by functional changes associated with dementia: Decreased inhibition of inappropriate behaviors (eg patients undress in public places.) Misinterpretation of visual and auditory cues (eg can they resist treatments. they perceive as an attack) Restricted short-term memory (eg. as they keep asking for things that they have already received) Reduced ability or inability to express needs (they wander z. B. because they lonely, fearful or on the looking for something or someone) patients with dementia often fit very poorly to the rules of institutional life. Mealtimes, bedtimes and times for toileting are not individualized. Many elderly patients with dementia develop or reinforce behavioral or psychological symptoms after they have moved to a more restrictive unfamiliar environment. Physical problems (eg. As pain, shortness of breath, urinary retention, constipation, physical abuse) can enhance behavioral and psychological symptoms, partly because the patient can not communicate adequately what the problem is. Physical problems can lead to delirium, and delirium, the auflagert to a chronic dementia may worsen the behavioral symptom. Rating characterization of behaviors (eg. As the Cohen-Mansfield scale) detection of specific behaviors clarification of co-existing depression and psychosis The best approach is to characterization and classification of behavior and less in the Benennnung all behavioral problems as agitation, a term that has many meanings and thus is not very helpful. The Cohen-Mansfield scale is often used; classifies behaviors as follows: Physically aggressive ,: z. As hitting, pushing, kicking, biting, scratching or packing of persons or things not physically aggressive ,: z. B. inappropriate handling things, hiding things, improper dressing and undressing, walking back and forth, repeating mannerisms or movements, restless act or attempts to go elsewhere verbal aggressive: z. B. swearing, bringing forth strange noises, crying or temper Not verbally aggressive: z. B. complaints, whining, constant Heischen for attention, aversion to everything, interrupting with relevant or irrelevant comments or negative or overbearing demeanor The following information should be recorded: Specific behaviors Precipitating events (such as eating, toileting, medication administration, visits.) time when the behavior began and has stopped should be included This information helps to identify changes in the pattern or the intensity of behavior and therefore make planning a strategy for dealing with the problem easier. If the behavior changes, a physical examination should be performed to rule out physical disorders and ill-treatment, but environmental changes (eg. As another caregiver) should also be noted, as these, rather than a patient-related factor may be due. Depression, which is common in patients with dementia may affect the behavior and needs to be identified. It can manifest initially as abrupt change in cognition, decreased appetite, worsening of mood, change in sleep patterns (often hypersomnolence) sudden, withdrawal, decreased activity level, crying spells, talking about death and dying, sudden development of irritability or psychosis or behavioral changes. Often depression is first suspected by the family members. Psychotic behavior must also be determined because the treatment strategy is different. The presence of delusions or hallucinations displays a psychosis. Delusions and hallucinations need of disorientation, anxiety and confusion, all of which occur frequently in patients with dementia are differentiated: delusions without persecution ideas can be mixed with disorientation, but delusions are mostly fixed (a nursing home is often called a prison), and the disorientation varied (z. B. the nursing home is referred to as a prison, restaurant or at home). Hallucinations occur without external sensory stimuli; Hallucinations should be distinguished from illusions that involve the wrong interpretation of external sensory stimuli (eg. As mobile phones, pagers). Antiarrhythmic therapy for environment customization and support of nurses drugs only when necessary Dealing with behavioral and psychological symptoms of dementia is controversial and has been studied very little. Supportive measures are preferable, but often drugs are used. Measures to adapt the environment The environment should be safe and flexible enough to allow behaviors that are not dangerous. Clues that can help the patient to find the way, and doors that are equipped with locks or alarm systems can help to ensure security around wandering patients. Flexible bedtimes and the design of the beds can help with sleep problems patients. Measures for the treatment of dementia usually wear also helps to minimize behavioral symptoms: providing clues to location and time explaining the care measures before they are carried out Promoting physical activity can an institution for a particular patient not provide adequate environment should this patient instead of a drug treatment, preferably in such an environment laid werden.Unterstützung of nurses a support of nurses is essential. If family members and other caregivers understand how to behave related dementia and performs psychological symptoms and how they have to respond to disruptive behavior, this may help them to communicate to the patient care and better cope with it. The nurses have to learn to deal with stress, which can be very substantial. Burdened caregivers should be referred to support services (eg. As social workers, support groups for caregivers, home care aids) and be informed about how a short-term care is to get, if one is available those available. Family caregivers should be monitored for depression; This occurs in almost half of the caregivers. A depression in caregivers should werden.Einnahme treated promptly of medicinal drugs that improve cognition (eg. As cholinesterase inhibitors) can also help to manage behavioral and psychological symptoms in patients with dementia. However, drugs that are primarily focused on the behavior (eg. As antipsychotics), only used when other approaches are inadequate medicines and essential for the safety of the patient. The need for continued therapy should be re-examined every month at least. The drug should be selected so that it targets the most disruptive behavior. Antidepressants, preferably SSRI, should signs of depression with prescribed werden.Antipsychotika antipsychotics are often used, although their effectiveness has been demonstrated only in psychotic patients only in patients. Other patients unlikely to benefit them and learn very common adverse effects, v. a. extrapyramidal symptoms. A tardive dyskinesia or tardive dystonia may develop. Often these disorders are not regress when the dose is reduced or the drug is discontinued. The choice of antipsychotic depends on its relative toxicity. Among conventional antipsychotics haloperidol has relatively low sedative and anticholinergic effects less severe, but it gets most likely to produce extrapyramidal symptoms. Thioridazine and thiothixene cause rather rare extrapyramidal symptoms, but they are more sedating and have pronounced anticholinergic effects than haloperidol. The second-generation antipsychotics (. Atypical antipsychotics, for example, aripiprazole, olanzapine, quetiapine, risperidone) seem minimal anticholinergic and cause fewer extrapyramidal symptoms than conventional antipsychotics; However, these drugs can, when used for a long time, be associated with an increased risk of hyperglycemia and mortality from various causes. They can also increase the risk of stroke in elderly patients with dementia-related psychosis. Antipsychotics are used, they should (in low dose 2.5-15 mg olanzapine / day po; h risperidone 0.5-3 mg PO every 12; Haloperidol 0.5-1 mg po, iv or 2 times daily or be given as needed), and only for a short time. (Editor’s note:. In the antipsychotic treatment of patients with dementia, there is the haloperidol iv must be given what is possible just only ECG monitoring probably very rarely come to such escalation) Other medications Anticonvulsants, especially valproate, can at the control of impulsive behavior outbreaks be useful. Sedatives (. E.g., short-acting benzodiazepines such as lorazepam 0.5 mg p.o. every 12 hours as needed) are sometimes used for a short time in order to alleviate event-related anxiety; such treatment is not recommended for long periods. Key Points What constitutes disruptive behavior, though is subjective and variable, but are behavioral disorders, the reason for up to 50% of admissions to nursing homes. The handling gets worse when patients are taken out of their familiar home environment. Behavioral disorders can be caused by a physical problem that the patient can not communicate. Categorizing behavioral done with the Cohen-Mansfield scale. Note the signs of depression such as abrupt changes in cognition, decreased appetite, worsening of mood, change in sleep patterns (often hypersomnolence), withdrawal, decreased activity level, crying spells, talking about death and dying and sudden development of irritability or psychosis , Treat using the environmental adaptation, and if you avoid the use of drugs. For more information BPSD Algorithm

Health Life Media Team

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