Neuropsychiatric Symptoms in Cognitive Impairment and Dementia: A Brief Introductory Overview

Ana Verdelho and Manuel Gon^alves-Pereira

I am myself and my circumstance; and if I do not save it, I do not save myself.

Meditations on Quixote

Jose Ortega y Gasset, 1914

The Behavioral and Psychological Symptoms of Dementia

Neuropsychiatric symptoms in cognitive impairment mainly include the so-called “behavioral and psychological symptoms of dementia”. This designation and the corresponding abbreviation (BPSD) were coined by influential consensus conferences convened by the International Psychogeriatric Association (IPA) in 1996 and 1999 [1]. BPSD were defined as “symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia.” Ever since, an IPA task force has been dedicated to the study of BPSD and the provision of continuous professional education in this field, including the regular publication of a guide for practitioners [2].

BPSD constitute a heterogeneous array of symptoms, signs, and syndromes and have been grouped according to different clinical and research contributions [3], partly building on pioneer work with questionnaires like the Cohen-Mansfield Agitation Inventory [4] or the Neuropsychiatric Inventory [5]. In general, “positive”

A. Verdelho

Department of Neurosciences and Mental Health, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, Instituto de Medicina Molecular (IMM) and Instituto de Saude Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

M. Gonfalves-Pereira (*)

CEDOC, Chronic Diseases Research Center, Nova Medical School, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Campo Martires da Patria, 130,

1169-056 Lisboa, Portugal e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017 1

A. Verdelho, M. Gonfalves-Pereira (eds.), Neuropsychiatric Symptoms of Cognitive Impairment and Dementia, Neuropsychiatric Symptoms of Neurological Disease, DOI 10.1007/978-3-319-39138-0_1

behavior (presence of something unusual - e.g., aggression, wandering) contrasts with “negative” behavior (lack of something usual - e.g., poverty of emotion, noncommunicativeness). Van der Linde et al. reviewed 62 studies and identified the following groups as the most consistent: affective symptoms, including depression and anxiety; psychosis, including delusions and hallucinations; hyperactivity, including irritability and aggression; and euphoria. They advised clinicians to consider each symptom in its own right and to be aware of relationships between them

[3]. A clinical distinction is often made between behavioral (known from direct observation) and psychological (known from interviews with patients and relatives) issues. The IPA Guide to BPSD thus describes both behavioral (wandering, agita- tion/aggression, resistiveness to care, inappropriate sexual behaviors, catastrophic reactions, sundowning) and psychological (psychosis-delusions, hallucinations- misidentification, depression, anxiety, apathy) symptomatologies [2].

Overall, BPSD are present in up to 97 % of clinical situations, including community and nursing-home populations. These symptoms are responsible for premature institutionalizations, huge direct and indirect costs, and above all considerable suffering and diminished quality of life on the part of persons with dementia and their families [2, 6].

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