Behavioral and Psychological Symptoms of Dementia BPSD .

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Behavioural and Psychological Symptoms of Dementia (BPSD). James Warner St Charles Hospital & Imperial College, London. Objectives. to understand the epidemiology and presentation of the behavioural and psychological symptoms of dementia
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Behavioral and Psychological Symptoms of Dementia (BPSD) James Warner St Charles Hospital & Imperial College, London

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Objectives to comprehend the study of disease transmission and presentation of the behavioral and mental side effects of dementia to comprehend the treatment ways to deal with the behavioral and mental manifestations of dementia

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van der Flier and Scheltens 2005 JNNP

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Dementia the study of disease transmission 6% of people more than 65 1 20% of people more than 80 700,000 cases in UK right now 2 Current cost of dementia £14.3bn – more than stroke, coronary illness and tumor joined Number of individuals with dementia will increment by 40% in next 15 years Lobo et al 2001 Alzheimer\'s general public, 2007

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Dementia-the study of disease transmission Alzheimer\'s disease 50% Vascular dementia 20% Mixed AD/Vascular 20% Dementia with Lewy bodies 5%

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Alzheimer\'s infection… .. A confusion of memory?

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Extract from: Alzheimer A. Über eine eigenartige Erkrankung der Hirnrinde Allgemeine Zeitschrift hide Psychiatrie und Psychisch-gerichtliche Medizin . 1907 "One of the primary malady side effects of a 51-year-old lady was a solid sentiment desire towards her better half. Soon she indicated quickly expanding memory disabilities; she couldn\'t discover her way about her home, she dragged questions and fro, concealed herself, or once in a while imagined that individuals were out to kill her, then she would begin to shout noisily."

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"From time to time she was totally insane, dragging her covers and sheets back and forth, requiring her better half and little girl, and appearing to have sound-related fantasies. Regularly she would shout for a considerable length of time and hours in a ghastly voice."

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Behavioral and Psychological Symptoms of Dementia (BPSD) " Alzheimer\'s sickness is the most generally experienced reason for psychiatric pathology connected with particular neuropathological substrate " Merriam 1988

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BPSD Vague and under-looked into albeit depicted plainly by Alois Alzheimer Term approved by 1996 IPA agreement gathering Not completely perceived in current demonstrative frameworks Bypassed by dementia procedure 2008 Not tended to satisfactorily by a few rules

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BPSD Seen in: ≈ 40% of mellow intellectual impedance ≈ 60% of patients in early phase of dementia influences 90-100% of patients with dementia eventually over the span of their disease Gets more incessant and troublesome with propelling dementia

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BPSD-characterization Various frameworks conceivable Symptom based e.g. "depressive" "hallucinating" Psychological versus behavioral Syndrome based Alzheimer\'s, Lewy body and so on

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BPSD-behavioral indications

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BPSD-mental side effects

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BPSD causes Physical Neuro-compound Environmental Emotional

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BPSD outcomes Associated with more prominent utilitarian weakness Very troubling for individual Very upsetting for carers Institutional care Overmedication Elder mishandle Associated with expanded mortality

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BPSD-appraisal physical wellbeing undetected agony or inconvenience symptoms of drug individual life history, including otherworldly and social personality psychosocial components physical ecological variables behavioral and practical examination directed by experts with particular aptitudes, in conjunction with carers and care specialists. Pleasant 2006

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BPSD Management

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Treatment choices Identify cause Wait and see? Instruction and advising Prophylaxis Environmental adjustment Direct behavioral methodologies Medication

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Identify cause BPSD might be because of physical cause restorative audit to prohibit: Constipation Pain Medication (torment executioners, tranquilizers) Infection Heart disappointment/hypoxia

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case #1 Erica 80, Alzheimer\'s ailment In proceeding with care Very serious dementia Usually no verbal reaction Staff saw increment in trouble frowning and not eating

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Wait and see? May be brief and self-constraining

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Prophylaxis Sleep-wake cycle Sleep cleanliness Exposure to sunshine Melatonin Exercise Stimulation

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Education and bolster Important May help carers comprehend and endure indications Facilitates improvement of imaginative diversions

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Case illustration # 2 Greta, 68 Vascular/Alcohol dementia Living with spouse Husband in extensive trouble "she declines to flush the latrine" "she won\'t make some tea appropriately" Frustration prompted struggle

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BPSD-administration Environmental change Sleep cleanliness Stimulation/commotion levels Exercise Food/hydration Lighting Grid-design flooring Relate issue to individual\'s biography

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case # 3 Jenny, 79, living in cellar level with accomplice Alzheimer\'s malady analyzed 8 years prior Developed sundowning disorder Partner: " she\'s going frantic specialist " Locked front entryway Wrestled Plied liquor

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case # 4 Ted, 74, Alzheimer\'s illness Living in private home "forceful and brutal", particularly at mealtimes

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BPSD administration fragrance based treatment multisensory incitement remedial utilization of music or potentially moving creature helped treatment rub NICE 2006

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BPSD administration Behavioral methodologies Individually custom fitted Driven by examination Delivered via prepared staff Sustained exertion

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case # 5 Ben, 78, In private home after wife\'s passing Vascular dementia 3 years Constantly calling staff, day and night Not in trouble "ABC investigation"

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BPSD administration Drug treatment Last resort Should target particular side effects Specialist start Regular survey

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BPSD administration Depression/Anxiety Antidepressants? Unsettling/animosity Antipsychotics-NO! Anticholinesterases? Benzodiazepines? Mind-set stabilizers? Fancies/mental trips Antipsychotics?

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case # 6 Anne, 78 living alone Alzheimer\'s infection 4 years Paranoid Delusions neighbors and child taking Hearing "commotions" from roof Carbamazepine 100mg bd

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conclusions Behavioral and Psychological indications are center components of dementia BPSD expands trouble, carer weight and mortality Drug treatment ought to be a final resort Far more research is required on BPSD the study of disease transmission, cause and administration … one more slide

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EVIDEM-E 6-week randomized controlled trial Community abiding people with dementia (any stage, any sort) At minimum one BPSD manifestation Tailored practice bundle Individualized results

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