A Clinician’s Field Guide to Good Practice - Managing BPSD

This field guide provides clinicians with an overview of good practice in managing behavioural and psychological symptoms of dementia. It is separated into 12 modules, each of which include specific information relevant to the following aspects of the BPSD:

  • A description of the behaviour or psychological symptom and how it presents in dementia
  • Potential causes of the BPSD
  • Differential diagnosis
  • Measuring the BPSD
  • Prevalence of the BPSD
  • Effects of the BPSD on the person with dementia and others living with them or involved in providing care
  • Management strategies for the BPSD, including psychosocial, environmental and biological interventions
  • Conclusions, recommendations and limitations of the evidence presented

The modules also include a brief clinical scenario that encompasses BPSD presentation, assessment, strategies and outcomes.

Module 1: Behaviour management process

This module covers the importance of building rapport with the person making the referral, risk assessment of the person with dementia, a thorough assessment of the person with BPSD to generate potential strategies, and a management plan based on the assessment.

Module 2: General BPSD

This module covers the factors contributing to BPSD, its impact on the person with dementia, carers, family, care staff and other residents, and approaches and strategies in implementing and monitoring intervention.

Module 3: Aggression

This module covers the characteristics and causes of aggression in people living with dementia, and looks at antipsychotics, psychosocial interventions and behavioural therapy as intervention.

Module 4: Agitation

This module covers agitated behaviours in dementia, both physical and psychological, and looks at various psychological and pharmacological interventions.

Module 5: Anxiety

This module covers anxiety in dementia, multicomponent interventions targeting environmental, biological and psychosocial factors, and pharmacological treatment.

Module 6: Apathy

This module covers apathy, one of the most prevalent of the BPSD, and looks at psychosocial interventions, therapeutic recreation, pharmacotherapy, cholinesterase inhibitors and memantine as intervention methods.

Module 7: Depression

This module covers the types of depression as they presents in dementia, the need for urgent review in psychotic and suicidal depression, individualised psychosocial interventions, medication, and other therapy.

Module 8: Disinhibited behaviours

This module covers disinhibited behaviours in dementia, those associated with a reduced capacity to restrain or control immediate, impulsive responses, and examines differential diagnosis, identification of potentially modifiable behaviours, and behaviour-based and pharmacological strategies for intervention.

Module 9: Nocturnal disruption

This module covers the causes and symptoms of nocturnal disruption, impact on the health of the person with dementia, and management and treatment options. 

Module 10: Psychotic symptoms

This module covers the psychotic symptoms in dementia, which present as delusions or hallucinations indicative of a disturbance in the perception and/or appreciation of objective reality; it looks at individualised, psychosocial interventions and pharmacological treatment strategies.

Module 11: Vocally disruptive behaviour

This module covers vocally disruptive behaviour (VDB) in persons with dementia, its differing definitions, causes, discomfort and social isolation, and the effectiveness of therapeutic and pharmacological interventions.

Module 12: Wandering

This module covers one of the most challenging and problematic BPSD, and looks at understanding and addressing wandering behaviours.