Behavioral and Psychological Symptoms of Dementia and Related Conditions
The GSA Agitation in Alzheimer’s Disease Decision Tree
Agitation in Alzheimer's Disease (AAD) impacts nearly 80% of persons with Alzheimer's Disease and is a cause of significant distress for patients and family/professional caregivers. The Agitation in Alzheimer’s Disease Decision Tree walks the clinician through a range of non-pharmacologic treatment options and highlights rational use of pharmacotherapies as well as their hazards in this vulnerable population.
Informed by an expert panel, GSA developed the Agitation in Alzheimer’s Disease Decision Tree and it was presented as a poster at the GSA Annual Scientific Meeting in November 2022.
Pseudobulbar Affect
Pseudobulbar affect (PBA) is a relatively common disorder in patients with neurologic conditions that can have a substantial negative impact on quality of life. Characterized by sudden bouts of uncontrollable crying and/or laughing that are disproportionate or inappropriate to the social context and are not associated with depression or anxiety, PBA is often underrecognized and undertreated. Treatment options available for PBA can reduce symptoms and improve quality of life, and coordinated care from the interprofessional health care team, along with the patient’s caregivers, can optimize management and outcomes for patients.
- "Insights & Implications in Gerontology: Understanding Pseudobulbar Affect" publication (PDF format)
- "Insights & Implications in Gerontology: Understanding Pseudobulbar Affect" infographic (PDF format)
- "Insights & Implications in Gerontology: Understanding Pseudobulbar Affect" decision tree (PDF format)
Dementia-Related Psychosis
It is estimated that over 2 million Americans with dementia experience delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). This group of symptoms, known as dementia-related psychosis, may cause significant distress to individuals and their families. Although common, the condition frequently goes undetected in people who may be struggling with other complex behavioral and psychological symptoms of dementia.
Podcasts
Part 1: Diagnosing Dementia-Related Psychosis
Dementia-related psychosis, defined as hallucinations and delusions in individuals with dementia, is a distinct neuropsychiatric symptom. Dementia-related psychosis differs from psychosis that originates from delirium or a pre-existing psychotic disorder (e.g., schizophrenia). Dr. Gary Small explains the challenges to and approaches for detecting and diagnosing these symptoms.
Guest: Gary Small, MD
Chair, Psychiatry at Hackensack University Medical Center; Physician in Chief, Behavioral Health; Chair, GSA’s Workgroup on Dementia-Related Psychosis
Host: Judit Illes, BCL/LLB, MS, CPHQ
Director, Strategic Alliances, The Gerontological Society of America
This podcast episode is supported by Acadia Pharmaceuticals, Inc. Content was developed by The Gerontological Society of America (GSA).
Part 2: Dementia-Related Psychosis in Primary Care
Primary care providers (PCPs) are ideally positioned to recognize, diagnose, and provide care planning for individuals with dementia who experience psychosis. Dr. Alexis Eastman discusses the important role of PCPs in team-based approaches to care and shares examples of innovative healthcare delivery models that can support PCPs in addressing dementia-related psychosis.
Guest: Alexis Eastman, MD
Medical Director, Division of Geriatrics, University of Wisconsin Hospitals and Clinics; Associate Professor, University of Wisconsin School of Medicine and Public Health; Member, GSA’s Workgroup on Dementia-Related Psychosis
Host: Judit Illes, BCL/LLB, MS, CPHQ
Director, Strategic Alliances, The Gerontological Society of America
This podcast episode is supported by Acadia Pharmaceuticals, Inc. Content was developed by The Gerontological Society of America (GSA).
Part 3: Dementia-Related Psychosis in Long-Term Care
Individuals with dementia-related psychosis experience worse outcomes than those who do not have psychosis, including but not being limited to accelerated time to being admitted to a long-term care facility and accelerated mortality. The manifestation of hallucinations and delusions in residents with dementia can also prove challenging for long-term care staff. Dr. Chad Worz discusses how appropriate documentation of a diagnosis of dementia-related psychosis and related care interventions are an important part of delivering individualized care for residents.
Guest: Chad Worz, PharmD, BCGP
Executive Director and Chief Operating Officer, The American Society of Consultant Pharmacists (ASCP)
Host: Judit Illes, BCL/LLB, MS, CPHQ
Director, Strategic Alliances, The Gerontological Society of America
This podcast episode is supported by Acadia Pharmaceuticals, Inc. Content was developed by The Gerontological Society of America (GSA).
Publications
Dementia-Related Psychosis: Strategies to Address Barriers to Care Across Settings
GSA’s February 2021 white paper identifies challenges that persons with dementia-related psychosis and their caregivers encounter as they move through different health care settings. The challenges and strategies to address them are based on input from experts in primary care, neurology, geriatric psychiatry, and nursing. Proposed strategies include improving communication about dementia-related psychosis with persons with dementia and their families, developing new educational initiatives to support primary care teams, and enhancing approaches to care coordination among primary and specialty care through telehealth and new models of care.
Dementia-Related Psychosis: Gaps and Opportunities for Improving Quality of Care
GSA’s August 2019 report brings attention to the need for greater awareness of dementia-related psychosis within the medical community and better support for those affected. Currently, there is no consensus in the medical community on how to diagnose dementia-related psychosis, which is clinically distinct from psychosis in other disorders (e.g., schizophrenia). Documentation and coding of the condition are also not standardized, making it difficult to identify, monitor and appropriately manage symptoms. This publication seeks to fill a gap in the available literature by summarizing best practices for treating dementia-related psychosis and proposing improvements to advance quality of care.
