In JAMA Article, Geriatric Mental Health Experts Provide Guidance on Nonpharmacologic Treatments for Behavioral Symptoms of Dementia

Published Thursday, November 29, 2012

What began as a session at the AAGP 2011 Annual Meeting, and then evolved into more discussion and collaboration, is now an article in the November 21, 2012, issue of The Journal of the American Medical Association. In "Nonpharmacologic Management of Behavioral Symptoms in Dementia," Laura N. Gitlin, PhD, and AAGP members Helen C. Kales, MD, and Constantine G. Lyketsos, MD, MHS, describe common behavioral symptoms along with strategies for selecting evidence-based nonpharmacologic dementia treatments.

Behavior changes are among the most visible, disruptive and distressing symptoms of Alzheimer's disease and other dementias. From confusion, repetitive questioning and combativeness to wandering, hallucinations and loss of inhibition, the symptoms carry their own risks of injury. They affect patient's quality of life and that of the family caregiver. These symptoms have been a challenge to physicians, particularly since many medications carry significant risks and have been found to be relatively ineffective. Screening for early manifestations of behavioral symptoms is not routinely conducted and risk factors for behavioral occurrences may be missed and ultimately precipitate placement in a nursing home or other costly long-term care facility.

Yet, many of dementia's behavioral symptoms can be managed well, without medications, if physicians integrate behavioral management strategies into early, ongoing treatment, according to Johns Hopkins University School of Nursing professor Laura N. Gitlin, PhD; Johns Hopkins School of Medicine professor of Alzheimer's research Constantine G. Lyketsos, MD, MHS; and Helen C. Kales, MD, University of Michigan associate professor and research scientist at the VA Center for Clinical Management Research. In the JAMA article, the authors outline a six-step approach to help clinicians identify and effectively manage most behavioral symptoms of dementia.

  • Screen for behavioral symptoms early.
  • Identify symptoms.
  • Delineate the triggers and risk factors for the symptoms.
  • Choose the proper interventions. For example, an individual with dementia might wake repeatedly each night, voicing fear of being alone in the dark, despite continuous calming efforts. An intervention might mean simply using a nightlight in the patient's room, or adding long family walks in the evening, to help promote better sleep.
  • Evaluate the intervention to make sure that it's working.
  • Follow the patient's progress over time.

Clinicians play a key role by educating families and caregivers about dementia and about its behavioral symptoms (including why they occur). Clinicians also can provide tools and strategies to help caregivers prevent challenging behavioral symptoms. Thus, to reduce a patient's confusion and disorientation, a caregiver might be encouraged to break daily activities into small, simple steps and to establish structured routines. Low-tech interventions like these can reduce symptoms and unnecessary health care costs related to urgent visits to hospital emergency departments.

See the article online: http://jama.jamanetwork.com/article.aspx?articleid=1392543.