Optimal management of behavioural disorders associated with dementia

Behavioural disorders occur with great frequency in patients with dementia. They are the major reason for admission of these patients to nursing homes. However, there have been few controlled trials of many of the commonly used drugs to guide therapy. To treat these conditions successfully, an adequate description of target symptoms of the behaviours to be corrected and a thorough investigation to identify precipitating causes are essential. Behavioural problems in dementia patients may result from physical illnesses, adverse drug effects, environmental changes, psychiatric syndromes (i.e. depression, delirium or psychosis) or the dementing illness itself. Therapeutic strategies should address the underlying cause whenever possible. Although pharmacological therapies are commonly employed, their efficacy is often modest and adverse effects can be quite significant. Ongoing reassessments are essential to maximise symptomatic benefits and minimise adverse effects. Several trials with different drugs are often necessary before an effective therapy is found. Anticholinergic adverse effects, which occur commonly with many antipsychotic and antidepressant medications, may worsen the cognitive and memory deficits that form the primary symptoms of dementia in these patients. This article summarises the use of the various psychoactive medications that target common behavioural disturbances, including agitation, psychosis, depression and sleep disturbances, in dementia patients. General guidelines regarding dosage, potential adverse effects and duration of therapy are discussed.