BPSD stands for Behavioural and Psychological Symptoms of Dementia.

BPSD refers to the non_cognitive symptoms of Dementia, particularly in the middle and later stages.

It is estimated that up to 90% of people with dementia will experience Behavioural and Psychological Symptoms of Dementia (BPSD) at some time during their journey with Dementia.

Behaviours may result from any combination of neurodegenerative damage associated with the disease itself, unmet physical needs such as pain or discomfort, the environment they are currently in and unmet psychosocial needs, such as the need for meaningful human contact or fear.

Some examples of the BPSD are:

  • repetitive behaviour;
  • mood disturbance (e.g. depression);
  • social inappropriateness;
  • agitation;
  • wandering;
  • psychosis, which may include delusions (false beliefs) and hallucinations (seeing or hearing things that are not actually there);
  • physical aggression; and
  • sleep disturbance.

Commonly, BPSD is treated using the medical model that leads to a pathway of Chemical Restraint, Sectioning and Involuntary Care.

As an example, the model will suggest treating pain but does not mention that something as simple CoCodamol which may exacerbate BPSD by causing constipation thereby causing a cluster of symptoms which will eventually lead down the BPSD pathway.

It may also suggest reducing existing medications, well surely reader you wouldn’t be on any medication that was not needed. If any of my medications were stopped and not replaced by something that wouldn’t have a negative impact on BPSD, in time they could lead to the appearance of a cluster of BPSD symptoms and other medical problems moving on to sectioning and involuntary care.

There doesn’t seem to be any general recognition of environment in any of this either. If assessments for BPSD are done outside the home environment, any number of factors could lead to the appearance of BPSD.

The British Medical Journal article Behavioural and Psychological Symptoms of Dementia (BPSD) . The issue is the cause not the cure goes some way to pointing to environment as a cause.

Below is a summary of seven of the most common deficits seen in dementia that are most clearly linked to specific regions of the brain.

These are known as the 7 A’s:

1. Anosognosia – lack of insight into one’s deficits or illness attributable to temporo-parietal pathology.

2. Amnesia – loss of short-term and long-term memory due to pathology in the hippocampus and/or the temporal lobe. Short-term memory loss causes difficulty learning new information; long-term memory loss causes difficulty recalling
previously learned information and occurs in reverse order to the memory storage process (i.e. loss progresses from most recent to most remote).

3. Aphasia – loss of language expression or comprehension. In expressive aphasia (due to damage of Broca’s area of the frontal lobe), the individual may be able to comprehend speech, but is unable to express him or herself. In contrast, a person with receptive aphasia (due to damage of Wernicke’s area of the temporal/parietal lobe) may be able to express him or herself, but has impaired comprehension.
4. Agnosia – loss of ability to recognize people (including self), objects, or sounds despite intact sensory modalities of vision, touch, and hearing. The damaged area is the parietal lobe.
5. Apraxia – an inability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform them, due to impaired motor planning and sequencing processes controlled by the parietal lobe.
6. Altered perceptions – altered depth perception, visual distortions, and altered tactile perception are commonly seen in dementia due to damage to the parietal lobe.
7. Apathy – an inability to initiate activities or conversation due to damage in the
frontal lobe.

…any of which may contribute to BPSD.

The broken lens of BPSD: why we need to rethink the way we label the behaviour of people who live with Alzheimer’s Disease

Polypharmacy which refers to the use of a large number of medications, commonly considered to be the use of five or more. Since polypharmacy is a consequence of having several underlying medical conditions, it is much more common in elderly patients and may be another cause of BPSD.

However, as an example, Primary Care in Ireland Definition , Assessment of a person with BPSD may be one of the better medical models however in their Medication Review they talk about stopping some treatments not replacing with other more suitable treatments, for example, Digoxin but not what to replace it with, which again could cause the appearance of a cluster of BPSD symptoms and other medical problems.

Kate Swaffer CEO of Dementia Alliance International recently wrote an article

Rethinking Dementia Care: Ban BPSD

Tomorrow reader, I will go on to give my opinion about why we should ban the medical model of BPSD in favour of a social model that retains empowers person and uphold the rights of a person living with Dementia.

However reader, the campaign to Ban BPSD does not advocate the complete removal of the use of antipsychotics in the treatment of Dementia, rather the ban on their inappropriate use which abuses the person and their rights.

Behavioural and Psychological Symptoms of Dementia (BPSD) – Why Ban It