Psychiatric and Behavioral Problems: Pharmacological Approaches: Philippe H. Robert
Alzheimer’s Disease (AD) is characterized by neuropsychological and neurological deficits associated with behavior problems. The latter have received much less attention than cognitive symptoms in studies of dementia in the past. However, these disturbances are important manifestations of AD and other forms of dementia because they are associated with caregiver distress, increase the likelihood of institutionalization, and may be associated with more rapid cognitive decline (Mortimer & Ebbitt, 1992; Teri, Hughes, & Larson, 1990). Several terms, such as behavioral disturbances and noncognitive symptoms, have been used to describe these manifestations, and they are only briefly mentioned in major manuals for the classification and diagnosis of mental disorders. For example, the criteria for dementia of the ICD-10 Classification of Mental and Behavioural Disorders (ICD 10; World Health Organization, 1993) include certain behavioral symptoms such as deteriorating emotional control, social behavior, and motivation. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV; American Psychiatric Association, 1994), the diagnostic criteria of AD specifies subtypes based on either age at onset or clinical features such as delirium, delusions, and depressed mood. Furthermore, the specifier “with behavioral disturbances,” which cannot be coded, is used to indicate clinically significant behavioral disturbances, such as wandering. Given the need for a better understanding and description of the origin, diagnosis, and treatment of behavioral disturbances in dementia, the International Psychogeriatric Association (IPA) recently organized a consensus confer-
ence on this topic. The consensus statement (Finkel, Costa e Silva, Cohen, Miller, & Sartoruis, 1996) indicated that the chief characteristics of dementia include multiple cognitive deficits and a deteriorating course. In addition to the cognitive symptoms, people with dementia have other symptoms that have been largely neglected until recently. These other symptoms commonly have been called behavioral disturbances of dementia. The participants of the conference thought that the term disturbances is too general, has many meanings, and is difficult to define. They recommended that the term behavioral disturbances be replaced by the term behavioral and psychological symptoms of dementia (BPSD), defined as follows: Signs and symptoms of disturbed perception, thought content, mood, or behavior that frequently occur in patients with dementia.