DESK REVIEWS | 07.02.01.02.02. Assessment and management of behavioural and psychological symptoms of dementia

DESK REVIEW | 07.02.01.02.02. Assessment and management of behavioural and psychological symptoms of dementia

This may be done, but there is no standard protocol. The neurologist or geriatrician is likely to do this during consultation. For the prescription of free anticholinesterase the specialist has to do the CDR (severity) and MMSE (cognition), but nothing regarding BPSD.

Specialists are equipped to assess people with dementia that are exhibiting psychological symptoms and challenging behaviours. The Clinical Practice Guidelines published by the Indian Psychiatric Society (IPS) (initially in 2007 and revised in 2018) contains a protocol for identification and management of challenging behaviours through pharmacological and non-pharmacological interventions (Shaji et al., 2018). For example, it provides an overview of the drugs recommended for management of behavioural and psychological symptoms of dementia (Shaji et al., 2018).

Non-pharmacological interventions for behavioural and psychological symptoms of dementia have been identified as a key intervention in dementia care. It is recommended for psychological interventions to be explored first before administering pharmacological therapies (Shaji et al., 2018). These psychological interventions have been found to work best when individually tailored to the patient (person-centred care) (Shaji et al., 2018). Cognitive stimulation programmes are beneficial in improving and maintaining the functionality for Activities of Daily Living (ADL). Other interventions like reality orientation and reminiscence therapy are also recommended (Shaji et al., 2018).

References:

Shaji, K.S., Sivakumar, P.T., Rao, G.P., Paul, N., (2018). Clinical Practice Guidelines for Management of Dementia. Indian J. Psychiatry 60, S312–S328. https://doi.org/10.4103/0019-5545.224472

An assessment for behavioural and psychological symptoms of dementia (BPSD) is not routinely performed among older people or people who have been diagnosed with dementia. The Ministry of Health is currently planning a guideline for primary care, and this might include the Neuropsychiatric Inventory (NPI) to assess BPSD. The NPI, however, is commonly used for assessment in memory clinics.

Similar to diagnosis, management is provided at referral county hospitals by psychiatric nurses and psychologists in counties where psychologists are integrated within the health system.

Not as part of public or social security services and no information is available from any private (profit or non-profit) services that offer these services. Some specialists could offer these, but no information is available publicly that we could document.

Mental health service users in the public sector are assessed using neurophysiological tests (see Vally, 2010, p.393). The following are largely provided by the private sector, NGOs and FBO’s which provide services to persons living with dementia and their families: non-pharmacological approaches include identifying environmental triggers for behavioural and psychological symptoms of dementia (BPSD) and empowering carers to manage these symptoms. Organisations such as ASA and Dementia-SA assist caregivers, providing support and training on how to care for a person living with dementia, monitoring their well-being, and link to support services (e.g. respite care, home-based care, support groups and counselling, and legal advice) (Emsley et al., 2013). Community-based services refer families where necessary to family physicians, specialists (i.e., private sector) for pharmacological approaches to manage BPSD as State facilities continue to be challenged by (1) serious shortages of essential list medications, (2) lack of understanding of dementia as a disease (and not a natural part of aging), and (3) lack of human resources to manage cases and monitor pharmacological treatments, effects, and dosages.

References:

Emsley, R., Seedat, S., & Van Staden, W. (2013). South African Journal of Psychiatry PART 2. The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders Head of Publishing. South African Journal of Family Practice, 19(No. 3), 196. https://doi.org/DOI:10.7196/SAJP.474

Vally, Z. (2010). The assessment and management of dementia. South African Family Practice, 52(5), 392–395. https://doi.org/10.1080/20786204.2010.10874014