Retain
– The behavioral and psychological symptoms of dementia concern most patients with neurocognitive disease at one time or another.
– The risk factors and determinants are numerous, heterogeneous and concern the patient, his environment, as well as family and professional caregivers.
– The resolution of these disorders involves an identification and taking into account as early as possible of etiological factors.
The behavioral and psychological symptoms of dementia (SCPD) bring together very heterogeneous manifestations, at the forefront of which are apathy, depression, agitation and aggressiveness, anxiety or even sleep disorders. Other signs or symptoms may also occur as delusional ideas, aberrant motor behavior, disinhibition, hallucinations, or even instinctual behaviors (food, sleep). The French Society of Gériatrie and Gérontologie, the Federation of Memory Centers and the French -speaking Society of Psychogeriatrics and Psychiatry of the Elderly (SF3PA) issued new recommendations in September 2024 On the subject that invite a more global approach.
A growing prevalence in France
In 2019, France had 1.2 million people with dementia And this number should grow with the aging of the population to reach 2.2 to 2.3 million in 2050. The SCPDs affect up to 90 % of the patients at one time or another from the evolution of their pathology. They are often associated and entangled with each other and significantly impact the quality of life of patients and that of those around them. They also condition the evolution of the disease and complicate its taking in care.
Etiological factors associated with behavioral and psychological symptoms of dementia
New recommendations for taking care of psychological and behavioral symptoms in neurocognitive diseases identify a large number of risk factors or precipitating factors:
– Somatic: pain, infections, electrolytic imbalance and metabolic disorders, urinary retention, constipation … Pain is a frequent cause of SCPD, insufficiently detected and often subcontracted in subjects with dementia. According to a recent meta-analysis, it alone increases 25 % The risk of SCPD and must therefore be sought.
– Environmental: hospitalization or institutionalization, lost object, decrease in brightness … Certain moments of the day are identified as being more at risk: Meal, toilet, falling from the night… In addition, they must be the subject of special attention.
– Psychological/psychiatric: feeling of solitude, decompensation of an old psychiatric disorder or appearance of a new one (anxiety/depression) … The seniority of the disease, in particular Alzheimer’s disease, and the severity of cognitive disorders increase the risk of SCPD.
In addition, the characteristics of caregivers play a decisive role. For example, an inappropriate attitude or communication increases the risk of SCPD, often by ignorance of the disease (inadequacy between the expectations of the caregiver and the patient’s capacities), especially since the patient’s verbal communication capacities are altered. The exhaustion, isolation or depression of caregivers of course come into account.
A more integrated approach: a real necessity!
Drug management, which is essentially based on antipsychotics, shows limited efficiency and not devoid of undesirable effects impacting morbidity and mortality. This is why, based on robust data from the literature, French recommendations place non -drug interventions (music therapy, adapted physical activity, psychoeducation, etc.) on the front line. They invite you to develop ” Multidomaine and personalized management from the diagnosis and evaluation of the symptom, until the implementation of non -pharmacological and pharmacological treatment when indicated ». This implies anticipating by identifying the risk factors and other determinants of SCPDs so as to act early in terms of medical intervention, but also environmental control, behavioral, financial measures, or even health education. The training, support and support for family caregivers and professionals appear just as essential.
