Notes

Psychotic Dementia Treatment
Psychotic Dementia Treatment
Individuals with dementia may have prominent and disabling behavioral symptoms, previously known as behavioural and psychological symptoms of dementia (BPSD). dementia tracker These are characterized by agitation, depression, apathy, delusions, hallucinations, or sleep disturbances. They have significant adverse effects on patients and their caregivers, leading to worse quality of life and faster cognitive decline.

BPSD clusters are often present as part of a syndrome that includes a range of physical and psychiatric conditions, including delirium, neurologic disease, infection, metabolic abnormalities, depression, psychotic disorders, and drug-related mood or psychotic syndromes. They are a concern for clinicians and caregivers, since they can be distressing to the patient and cause further cognitive impairment, resulting in increased institutionalization.

The first-line approach to the treatment of NPSs in dementia is to identify and treat the underlying precipitating condition. Nonpharmacologic treatments include cognitive reorientation, behavioral therapy, and social support, as well as the use of antidepressants, serotonin reuptake inhibitors (SSRIs), and other SSRI-like drugs to reduce repetitive behaviors that are associated with NPSs.

dementia wandering at night Pharmacologic options for NPSs in dementia are benzodiazepines, cholinesterase inhibitors (ChEIs), atypical antipsychotics, and the atypical antipsychotic-like drugs olanzapine and risperidone. Benzodiazepines are effective in most cases and should be considered as first-line treatment for the most severe agitation/aggression and/or psychosis.

We used Medicare claims data from 2008 to 2016 to evaluate existing treatment patterns for NPSs in patients with dementia. Outcomes included the agents prescribed for NPSs, time to first use, and patterns of treatment use (treatment continuers, discontinuers, and switchers). Over three-quarters (76.8%) of patients with NPSs received a pharmacologic agent, primarily an antipsychotic or divalproex.
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