Nonpharmacologic Management of Behavioral Symptoms in Dementia
Open accessAbstract
Behavioral symptoms such as repetitive speech, wandering, and sleep disturbances are a core clinical feature of Alzheimer disease and related dementias. If untreated, these behaviors can accelerate disease progression, worsen functional decline and quality of life, cause significant caregiver distress, and result in earlier nursing home placement. Systematic screening for behavioral symptoms in dementia is an important prevention strategy that facilitates early treatment of behavioral symptoms by identifying underlying causes and tailoring a treatment plan. First-line nonpharmacologic treatments are recommended because available pharmacologic treatments are only modestly effective, have notable risks, and do not effectively treat some of the behaviors that family members and caregivers find most distressing. Examples of nonpharmacologic treatments include provision of caregiver education and support, training in problem solving, and targeted therapy directed at the underlying causes for specific behaviors (eg, implementing nighttime routines to address sleep disturbances). Based on an actual case, we characterize common behavioral symptoms and describe a strategy for selecting evidence-based nonpharmacologic dementia treatments. Nonpharmacologic management of behavioral symptoms in dementia can significantly improve quality of life and patient-caregiver satisfaction.
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Neuropsychiatric symptoms are both common and persistent in moderate to advanced disease stages.
“However, evidence suggests that NPS are both common and persistent in moderate to advanced disease stages.6, 55”
From Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies during Hospital to Skilled Nursing Facility Transitions (2021) · cites this paper as [55]
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Self-citationCummings, J. L., Lyketsos, C. G., Peskind, E. R., Porsteinsson, A. P., Mintzer, J. E., Scharre, D. W., De La Gandara, J. E., Agronin, M., Davis, C. S., Nguyen, U., et al. (2015) · JAMA · doi:10.1001/jama.2015.10214 · Cited by 209 · see citing works
Self-citationPsychosis in Alzheimer disease—mechanisms, genetics and therapeutic opportunities
Ismail, Z., Creese, B., Aarsland, D., Kales, H. C., Lyketsos, C. G., Sweet, R. A., & Ballard, C. (2022) · Nature Reviews Neurology · doi:10.1038/s41582-021-00597-3 · Cited by 189 · see citing works
Self-citationTargeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial
Gitlin, L. N., Arthur, P., Piersol, C., Hessels, V., Wu, S. S., Dai, Y., & Mann, W. C. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15194 · Cited by 119 · see citing works
Self-citationPromoting Reminiscences with Virtual Reality Headsets: A Pilot Study with People with Dementia
Coelho, T., Marques, C., Moreira, D., Soares, M., Portugal, P., Marques, A., Ferreira, A. R., Martins, S., & Fernandes, L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249301 · Cited by 79 · see citing works
Arthur, P. B., Gitlin, L. N., Kairalla, J. A., & Mann, W. C. (2018) · International Psychogeriatrics · doi:10.1017/s104161021700237x · Cited by 71 · see citing works
Self-citationde Oliveira, A. M., Radanovic, M., Homem de Mello, P. C., Buchain, P. C., Dias Vizzotto, A., Harder, J., Stella, F., Piersol, C. V., Gitlin, L. N., & Forlenza, O. V. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4958 · Cited by 67 · see citing works
Self-citationGitlin, L. N., Marx, K., Piersol, C. V., Hodgson, N. A., Huang, J., Roth, D. L., & Lyketsos, C. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02511-4 · Cited by 65 · see citing works
Self-citationCaregiver perspectives about using antipsychotics and other medications for symptoms of dementia
Kerns, J. W., Winter, J. D., Winter, K. M., Kerns, C. C., & Etz, R. S. (2018) · The Gerontologist · doi:10.1093/geront/gnx042 · Cited by 62 · see citing works
Virtual Reality for Therapeutic Recreation in Dementia Hospice Care: A Feasibility Study
Ferguson, C., Shade, M. Y., Blaskewicz Boron, J., Lyden, E., & Manley, N. A. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120901525 · Cited by 57 · see citing works
Fraker, J., Kales, H. C., Blazek, M., Kavanagh, J., & Gitlin, L. N. (2014) · Occupational Therapy In Health Care · doi:10.3109/07380577.2013.867468 · Cited by 33 · see citing works
Self-citationA 2023 update on the advancements in the treatment of agitation in Alzheimer’s disease
Lee, D., Clark, E. D., Antonsdottir, I. M., & Porsteinsson, A. P. (2023) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2023.2195539 · Cited by 28 · see citing works
Change in agitation in Alzheimer's disease in the placebo arm of a nine-week controlled trial
Rosenberg, P. B., Drye, L. T., Porsteinsson, A. P., Pollock, B. G., Devanand, D. P., Frangakis, C., Ismail, Z., Marano, C., Meinert, C. L., Mintzer, J. E., et al. (2015) · International Psychogeriatrics · doi:10.1017/s1041610215001106 · Cited by 28 · see citing works
Self-citationEffectiveness of “Reducing Disability in Alzheimer’s Disease” Among Dyads With Moderate Dementia
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Gitlin, L. N., Marx, K., Piersol, C. V., Hodgson, N. A., Parker, L. J., Cidav, T., & Roth, D. L. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17981 · Cited by 13 · see citing works
Self-citationGilmore-Bykovskyi, A. L., Hovanes, M., Mirr, J., & Block, L. (2021) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988720944245 · Cited by 14 · see citing works
“However, evidence suggests that NPS are both common and persistent in moderate to advanced disease stages.(6,55) Hence, there may also be a lack of continuity in understanding prior functioning and symptomatology that may subsequently hinder hospital providers’ true understanding of symptom history and thus communicat…”
Background
- Authors
- Gitlin, L. N., Kales, H. C., & Lyketsos, C. G.
- Affiliations
- Johns Hopkins University (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-11-21
- Volume
- 308
- Issue
- 19
- Pages
- 2020
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3711645
- OpenAlex
- W2129264765
- Cited by
- 495
- References
- 79
- Citations by year
- 2026: 18 · 2025: 29 · 2024: 31 · 2023: 28 · 2022: 54 · 2021: 51 · 2020: 32 · 2019: 41 · 2018: 47 · 2017: 44 · 2016: 38 · 2015: 39 · 2014: 33 · 2013: 9
- FWCI
- 18.50
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG022254, 1R01AG041781-01A, R01AG041781, R01 AG22254, P50AG005146)
- National Institute of Mental Health (R21MH069425)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Keywords
- dementia, behavioral symptoms, non-pharmacological treatment, Alzheimer's disease, wandering, repetitive speech, sleep disorders, caregiver education, caregiver support, screening, quality of life, nursing home admission
- MeSH terms
- Aged, Aged, 80 and over, Combined Modality Therapy, Dementia, Humans, Patient Care Planning, Problem Solving, Psychomotor Agitation, Quality of Life, Sleep Wake Disorders, Social Support, Caregivers, Disease Progression, Wandering Behavior
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