BPSD dementia: Symptoms with underlying causes

BPSD are symptoms that the majority (up to 90%) of people living with dementia experience. They can happen due to underlying reasons, such as needs, emotions or illness, that the person cannot communicate effectively.

What does BPSD mean?

BPSD dementia means Behavioural and Psychological Symptoms of Dementia.

They are not symptoms used to diagnose dementia, but rather symptoms extremely common in people who are already known to be living with dementia. These symptoms can be challenging or concerning for both the person experiencing them and their carers and loved ones.

Up to 90% of people who have dementia experience BPSD.

What are the symptoms of BPSD dementia?

The term BPSD was coined in the mid-1990s and traditionally doesn’t include core symptoms of dementia, such as memory loss and speech difficulties (aphasia). More recent research categorised BPSD into 5 key domains, which does include some cognitive symptoms.

What are the 5 domains of BPSD?

The 5 domains of BPSD symptoms are emotional, perceptual, verbal, motor and vegetative.

Emotional symptoms

• Depression
• Anxiety
• Apathy
• Irritability and agitation
• Anxiety
• Rapid mood swings
• Social withdrawal
• Low self-esteem
• Crying

Perceptual and cognitive symptoms

• Hallucinations
• Delusions
• Misinterpreting information from their senses
• Misidentifying people or places

Motor symptoms

• Wandering
• Pacing or other repetitive actions with no apparent purpose
• Shadowing
• Fidgeting
• Violence
• Inappropriate actions due to disinhibition

Verbal symptoms

• Verbal aggression
• Shouting
• Swearing (more than usual)
• Unreasonable demands
• Repeating the same questions, phrases or singing the same song
• Muttering incoherently
• Whining or wailing

Vegetative symptoms

• Difficulties with sleep
• Sundowning

Why does BPSD occur?

BPSD can often be a sign of underlying discomfort or distress that the person struggles to communicate to careers due to their dementia.

Unmet needs

• Hunger
• Thirst
• Needing the toilet
• Boredom
• Loneliness

Illness or physical health issues

• Pain
• Infection
• Delirium

Distress or discomfort in their current environment

• Confusion or fear
• Feeling misunderstood, dismissed, infantilised or patronised
• Feeling overstimulated or bombarded

Changes in the brain

• Atrophy in the brain as dementia progresses

Care and treatment for BPSD

Person-centred care is essential when supporting somebody experiencing BPSD. Healthcare professionals should always explore non-pharmacological approaches before any medication.

First line – non-pharmacological management of BPSD

Methods can include:

• Therapies such as:
  • Talking therapy
  • Cognitive behavioural therapy (CBT)
  • Cognitive stimulation therapy (CST)
  • Reminiscence therapy
  • Music therapy
  • Dementia dolls
  • Pet therapy
• Changes to the person’s environment.
• Exercise.

It may be appropriate in some situations to change the person’s care givers or care home. There are care homes that specialise in supporting people with behaviours of concern.

Second line – pharmacological management of BPSD

If non-pharmacological approaches don’t help, doctors may try medication to help relive the person’s BPSD. Here is an example of what medications they may prescribe, but each person’s unique experience and medical background will be taken into account. Some of the drugs on this list are antipsychotics, which can be extremely beneficial but can come with side-effects. Make sure you speak with the doctor and understand exactly what your loved one is being prescribed.

How to support someone with BPSD

Book an appointment with their GP

Your loved one’s GP should be your first point of call. They can assess and test for any minor health problems or infections that are causing your loved one pain or distress, or refer them for further investigation if they suspect there may be more going on.

The GP can identify BPSD and look at your loved one’s particular type of dementia and medical history and assess the best course of action.

If non-medical intervention doesn’t work, they can prescribe appropriate medications or evaluate whether any current medications may need to be changed.

Identify any patterns in their behaviour

Noticing when these behaviours occur could help you to get to the root of the underlying cause. Do they happen at a particular time of day? Or when they’re in a particular place? Or after discussing a certain topic?

Even if you can’t get right to the bottom of it, noticing what triggers the behaviour can help greatly, especially if you are able to avoid that trigger.

Support them to build a routine and have plenty to do

Routine and activity help with wandering, fidgeting and boredom.

Having a regular daily routine is vital for helping somebody living with dementia to feel normal, in control and purposeful. They may need visual aids to help them to remember their routine, such as simple picture and word signs around their home or a dementia clock.

Similarly, keeping busy is important for confidence, mental health and can actually help to keep the brain active. Having a manageable amount of stimulating activity in their days and weeks is greatly beneficial to somebody with BPSD.

Make time to listen

Everybody needs someone to talk to. Taking the time to let your loved one speak and really listen to them, without correcting inaccuracies in what they’re saying, can really help them to work through their feelings and boost their self-esteem.

There’s a method of communicating with people living with dementia called validation therapy. It’s where, instead of correcting the factual accuracy of what the person is saying, you validate the emotions behind it.

For example, they might keep saying their husband is at work, when in fact he died ten years ago. You recognise that they are thinking about their husband and talk about him together, rather than reminding them that he’s dead and causing distress.