ABSTRACT
References 72
The neuropsychiatric changes in dementia are nearly universal and may result in extremely challenging management problems. This is in spite of the definition of dementia being based on the cognitive and functional changes alone. The neuropsychiatric symptoms include personality changes, mood deterioration, perceptual abnormalities, psychomotor disturbances (such as agitation, aggression, wandering and purposeless behaviour) and neurovegetative changes, including changes in sleep and appetite. Collectively, these manifestations of dementia syndromes can be regarded under the rubric of ‘behavioural and psychological symptoms of dementia (BPSD; Finkel et al., 1996); however, they have been variously termed as ‘neuropsychiatric symptoms’, ‘behavioural disturbances’, ‘non-cognitive changes’ and ‘challenging behaviours’. Here we will refer to them as the neuropsychiatric symptoms of dementia. The importance and ubiquity of these symptoms is highlighted by Alois Alzheimer’s first clinical description of Alzheimer’s disease (AD) in 1907. In this case study, he stated:
The first noticeable symptoms of illness shown by this 51-year old woman was suspiciousness of her husband. Soon, a rapidly increasing memory impairment became evident; she could no longer orient herself in her own dwelling, dragged objects here and there and hid them, and at times, believing that people were out to murder her, started to scream loudly (Alzheimer, translated by Jarvik and Greenson, 1987).
