Download Management of Behavioural Symptoms of Dementia

Management Checklist for Behavioural Symptoms of Dementia
Name……………………………. D.O.B……………………………….. Date of Assessment…………………..
Management should focus around early recognition and prevention of behavoural symptoms of dementia, using
assessment and non drug management. Antipsychotics should only be prescribed as a last resort and for a defined length
of time. The need for ongoing antipsychotic treatment should be assessed by specialist services.
Medical Review
 Dehydration: assess fluid intake, constipation
 Pain: Assess for any possible causes of pain.
 Infection: especially UTI, chest infection
Medication Review
 Medication: avoid polypharmacy, codeine, anticholinergics including tricyclic
antidepressants, oxybutinin, long acting SSRIs.
 Be aware of possible serotonergic syndrome, drug induced delirium.
Clinical Review
 Delirium & confusion : treat according to guidance.
 Known Neuropsychiatric symptoms
 Depression: 4GDS >2 – treat appropriately-see local depression guidelines
Person centred care
 Environmental factors
 Assess severity of symptoms
 Address factors that may influence behaviour
MILD TO MODERATE SYMPTOMS
SEVERE SYMPTOMS
Refer any patient refusing to eat/drink
or needing restraint
WATCHFUL WAITING / NON DRUG TREATMENTS
ASSESS & document baseline:
Document symptom / incident, triggers and tried
intervention in individual care plan and review
regularly with carers/ staff . BADCHAVS tool.
o
CVA risk Cognition
o
Target symptoms
o
Co morbid conditions
Notes : Interventions should be tailored to the
individual and may include: CBT /psychosocial
therapy, diversion, reorientation, multisensory
stimulation & other simple interventions (e.g. if
hungry, in pain etc.)
o
Carer consent
Review progress regularly - If symptoms worsen,
unsuccessful then consider specific interventions
including psychosocial interventions / drug
therapies.
EXTREME RISK OR
DISTRESS
Severe distress /
Risk of harm to self or
others
RISK - BENEFIT documented & TARGET SYMPTOMS identified
If antipsychotics contra indicated, (e.g. stroke, Lewy Body
dementia) or ineffective, contact Older Persons Mental Health
team for advice.
Severe agitation or psychosis (with aggression): Start with a low
dose antipsychotic & titrate up according to response:
1st choice: Risperidone 250 microgram bd to max 1mg bd
2nd choice : Olanzapine 2.5mg od to bd
PSYCHOSOCIAL interventions: tailor activities to
individual needs & document in care plan.
PHARMACOLOGICAL therapies
Review at 6 weeks and / or every 12 weeks:
1.
Assess response: improvement in severity of symptoms.
2.
Monitor side effects: cognitive decline, target behaviour,
weight gain, BP drop / dizziness, glucose levels, EPSE,
sedation, constipation, fluid intake, signs of (chest)
infection.
3.
Reduce dose: If patient symptoms have improved and
stable for 3 to 6 months reduce the dose by 50% every 2
weeks with continued monitoring and then stop.
4.
Unless there is severe risk or extreme distress, the
recommended default management is to discontinue the
antipsychotic and continue to monitor/assess.
5.
Where continued antipsychotic treatment is clinically
necessary, referral to specialist services is advised.
Set next review date with ongoing management plan.
Analgesia: Paracetamol 1g up to qds
Mild to moderate agitation:
Lorazepam 0.5mg to 1 mg up to qds (short term)
Trazodone 50 to 300mg daily
Depression: Sertraline 50 to 100mg daily
Citalopram 10 to 20 mg OD
Sleep Disturbance: Zopiclone 3.75 to 7.5mg nocte
Temazepam 10mg nocte
Mood stabiliser: Carbamazepine 50 to 300mg daily
6.
Any other Comments:
Alzheimer’s SOCIETY. Optimising treatment and care for people with behavioural and psychological symptoms of dementia