Behavioral and Psychological Symptoms in Dementia

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.


Dementia is the colloquial term that denotes the nosological distinction of major neurocognitive disorder in the Diagnostic and Statistical Manual 5 edition (DSM 5). Dementia refers to a collection of symptoms stemming from a broad array of etiologies precipitating in functionally impairing cognitive decline. While the presence of cognitive impairment is necessary and sufficient for a diagnosis of dementia, associated neuropsychiatric symptoms -known collectively as behavioral and psychological symptoms of dementia, or BPSD - are prevalent and can significantly impact the prognosis and management of dementia. For this reason, DSM 5 requires clinicians to specify whether BPSD is present and to specify the degree of severity; for example, a diagnosis of Alzheimer's dementia might be coded as “major neurocognitive disorder due to Alzheimer's disease, with behavioral disturbances, severe.”

BPSD includes emotional, perceptual, and behavioral disturbances that are similar to those seen in psychiatric disorders. It may be clinically useful to classify them into five domains: cognitive/perceptual (delusions, hallucinations), motor (e.g., pacing, wandering, repetitive movements, physical aggression), verbal (e.g., yelling, calling out, repetitive speech, verbal aggression), emotional (e.g., euphoria, depression, apathy, anxiety, irritability), and vegetative (disturbances in sleep and appetite).

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