Relevance of emotions and beliefs in the treatment of behaviors that challenge in dementia patients

Abstract

SUMMARY Behavior and psychological symptoms of dementia (BPSD) is a term that is used to describe problematic behaviors perpetrated by people with progressive cognitive decline. Until recently, a rather medicalized perspective was used for BPSD and, thus, the treatments chiefly involved the use of psychotropic medication. Empirical evidence suggests that such treatments are largely ineffective and highly problematic. Indeed, for 1% of people receiving antipsychotics, such treatment is lethal. Owing to such issues, nonpharmacological therapies have been suggested as first-line treatments. However, owing to poor training and resources, and an inadequate evidence-base for many psychosocial approaches, the use of inappropriate medication remains common. This article takes a biopsychosocial view of BPSD, preferring the term ‘behaviors that challenge‘, illustrating that these behaviors are products of a number of factors, both individualistic and systemic. In this article, the roles of emotions and beliefs systems are highlighted, with specific examples given for interventions for anger in those with dementia. It demonstrates the vital role of working with healthcare systems, in particular carers, to bring about resolution. A new stepped-care model of treatment for behaviors that challenge is also presented. This model, recently presented to UK Parliament by James, is intended to encourage the use of evidence-based nonpharmacological strategies as alternatives to antipsychotics. This article is the first to illustrate the utility of the model with core study material.