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Care of the Aging Patient: From Evidence to Action
Clinician's Corner
November 21, 2012

Nonpharmacologic Management of Behavioral Symptoms in Dementia

Author Affiliations

Care of the Aging Patient Section Editor: Edward H. Livingston, MD, Deputy Editor, JAMA.

Author Affiliations: Department of Community Public Health in the School of Nursing, Department of Psychiatry and Division of Geriatrics and Gerontology in the School of Medicine, and Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, Maryland (Dr Gitlin); Section of Geriatric Psychiatry, Department of Psychiatry, and The Program for Positive Aging, University of Michigan, and VA Center for Clinical Management Research, and Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan (Dr Kales); and Department of Psychiatry, Johns Hopkins Bayview Medical Center, Baltimore, Maryland (Dr Lyketsos).

JAMA. 2012;308(19):2020-2029. doi:10.1001/jama.2012.36918

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.