The assessment of NCS 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?
Abbey Pain Scale
Pain Assessment in Advanced Dementia
Geriatric Depression Scale
Cornell Depression Scale