Sintomas psiquiátricos e comportamentais da demência

Abstract

Besides cognitive changes, dementia disorders have other very important symptoms. Some of these symptoms, that include an array of behavioral and psychiatric manifestations, are known as behavioral and psychiatric (or psychological) symptoms of dementia (BPSD). For several reasons they are an important case for General Practitioner consultation. Some of the se symptoms tend to oc cur si mul ta ne ously, in factors, such as psychosis (agitation and aggressiveness), mood (depression and anxiety), frontal behavior (desinhibition and euphoria), apathy and insomnia. The cause of these symptoms can be dementia itself, and in some situations they are a core diagnostic feature in the diagnosis. However, the possibility of a drug or a somatic disease as a cause for the se symptoms must always be actively sought, especially if the BPSD have a particular clinical presentation. So, the exclusion of another medial disorder (that is non demential) is mandatory. After excluding other causes, a treatment with an anti-dementia drug must be offered, as there is evidence that acetylcholines terase inhibitors and memantine improve, not only cognition, but also BPSD in some dementia (including Alzheimer's disease). Then, non-pharmacologial measures must be started. However, a pharmacological treatment with psychotropic drugs should also be started, if treatment is urgent or the symptoms severe. The symptom or symptoms should be identified and the therapeutic targeted for those specific symptoms. Despite the clinical trials performed with psychotropics for BPSD are uncommon and sometimes have questionable designs, it is very important to treat these symptoms. Care givers should also be instructed on how to deal with BPSD. Whenever a BPSD is difficult to control, especially if not improving after a trial with the measures here described, a referral for Neurologic or Psychiatric evaluation should be done. There ferral note should be “BPSD [specify] severe and not improving after treatment with [specify]”.