Dementia Pathways. For Primary Care in ireland

The assessment of BPSD is key to its successful management. The following three steps should always be followed when caring for a person with behavioural or psychological symptoms.

Step 1: Out-rule a delirium

  • Does the patient have an underlying acute medical condition? e.g. UTI, chest infection
  • Is there another potential causes of an abrupt change in behaviour? e.g. stroke, encephalitis, meningitis.
  • Physical Exam: Note consciousness level, vital signs, examine for signs of pulmonary infection, urinary retention, impaction
  • Request MSU

Step 2: Identify target behaviour

  • What symptom or behaviour are you attempting to treat, and why?
  • Have a clear description of the problem at hand;
    • When did the behaviour begin? Frequency? Time of day? When does it not occur?

Step 3: Identify any possible triggers for the behaviour

Behaviour can often be a form of communication. Consider the following triggers:

  • Is there an unmet physical need?
    •  Pain? Constipation? Injury? Cold? Hunger? Thirst?
  • Iatrogenic cause?
    • Inappropriate medication (see link below to our list of inappropriate medications in dementia) or potential side effect of a new medication  
  • Environmental trigger?
    • Noise? Over/under-stimulation? No wandering space?
  • Psychosocial factors?
    • Boredom? Loneliness? Staff/Carer Communication?