Dementia Pathways. For Primary Care in ireland

The initial management of BPSD in 3 steps

Step 1: Address potential triggers identified in the assessment. For example;

  • Commence regular analgesia
  • Stop inappropriate medications
  • Manage constipation
  • Treat any infections
  • Give communication tips to carers, e.g. use short simple sentences, avoid confronting or correcting the person unnecessarily, limit choice to minimise confusion

 

Step 2: Introduce a personalised intervention

  • Music: ask family members to make up tapes of songs that the person used to like or tapes of family member talking
  • Social interaction: suggest that a carer spends 10-15 minutes a day with the person reminiscing or having a conversation about a topic of interest to the individual. This will give significant benefit. A life story book is a good way of identifying the conversation and themes for reminiscence.
  • Increase day-time activity where possible this relieves boredom and improves night time sleep.
  • Aromatherapy: There is some modest evidence to support the use of lavender aromatherapy oils to decrease agitation

 

Step 3: Observervation

  • Observe the person for a period of time 1-4 weeks, if no improvement reassess for delirium/ triggers.

 

How to decide on whether to commence pharmacological treatment in BPSD in 3 steps

Step 1: Stop and Think: Is it warranted?

  • Is this symptom or behaviour of sufficient severity or impact to warrant medication?

 

Step 2: Stop and Think: Will it help?

  • If you have established that it warrants treatment the next step is to consider if this is a behaviour or symptom that will respond to medication.
  • Behaviours or symptoms that are unlikely to respond to medication include; wandering, inappropriate undressing, repetitive questioning, hiding & hoarding.

 

Step 3: Identify the symptom cluster

  • Identify the main cluster of symptoms and target your treatment to that cluster.
  • The pharmacological option chosen depends on the behaviour(s)/symptom(s) you are trying to treat. There is no “one size fits all” blanket treatment for BPSD
  • Examples of potential symptom clusters & the possible treatments are:
    • Anxiety/ Agitation: may respond to an SSRI
    • Agitation/Sleep Wake Cycle disturbance: may benefit from Trazadone in addition to sleep hygiene techniques
    • Aggression/Psychosis: if severe and risk to self or others consider antipsychotic - please review our information on antipsychotic prescribing.