Issues to be addressed

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Issues to be addressed

• Is BPSD one entity?
• Is BPSD part of the diagnosis of dementia?
• Are BPSD symptoms which cut across diagnoses?
• Which syndromes have been reliably identified in
  BPSD?
• Should drugs be developed to address BPSD?
• What are some of the issues that need to be
  addressed in the design of pharmacological drug
  studies for BPSD?

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Is BPSD one entity?
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Studies regarding the relationship between type
of agitation and level of cognitive functioning.
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(No Transcript)
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Is BPSD part of the diagnosis of dementia?
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Are BPSD symptoms which cut across diagnoses?
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Agitated Behaviors- diagnoses with similar
manifestations

• Normal
• Children with attention-deficit/hyperactivity
  disorder - motor hyperactivity
• Children or adolescents with conduct disorders -
  aggression
• Adults with intermittent explosive disorder -
  aggression
• Stereotypic movement disorder repetitive
  movements

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Delusions and Hallucinations- diagnoses with
similar manifestations

• Schizophrenia delusions and hallucinations

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Sleep problems- diagnoses with similar
manifestations

• substance abuse
• circadian rhythm sleep disorders

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Delusions and Hallucinations

• Delusions Confabulations
• Hallucinations Visual sensory deprivations

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Which syndromes have been reliably identified in
BPSD?
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Examples of studies of factor analyses in
agitation
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Syndromes

• Agitation 3 syndromes
• Psychotic symptoms delusions and hallucinations
• Depression depressed affect vs. vegetative
  symptoms

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Should drugs be developed to address BPSD?
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• Nonpharmacologic etiologies therapies

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Figure 2. Impact of nonpharmacologic
intervention Initial Results. N12
Residents Intervened 100 n12
Identified Needs 75 n9
Successful Intervention 42 n5
Partial success 33 n4
Failure 25 n3
1 Unresolved medical problems 1 Possible
candidate for pharmacological treatment 1 Severe
infectious disease
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• Which BPSDs need to be treated?
• Many BPSDs do not have to be treated.
• Some BPSDs should not be treated with
  psychotropic drugs.
• Etiology of the symptom needs to be determined
  and addressed. For a small proportion of
  patients whose behavior is dangerous or grossly
  disturbing, and no nonpharmacologic approach is
  effective, a pharmacologic approach is appropriate

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• Issues in pharmacologic drug studies for BPSD
  which need to be addressed
• Sample representativeness
• Impact on nontarget symptom

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Conclusion

• BPSD is not a diagnosis, nor can BPSD be
  considered symptoms which occur across diagnoses.
• A way to address BPSD is as a secondary
  diagnosis, such as dementia with aggressive
  features
• Several syndromes have been described
  consistently and reliably, and there is no
  shortage of assessment instruments to identify
  and quantify them.
• A reliable characterization is a necessary but
  not a sufficient condition for drug trials.

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Conclusion

• There is a need to
• Investigate the possible etiologies of behaviors
  or psychological symptoms. Therefore
• differentiate between psychiatric symptoms and
  natural sequelae of memory problems
• address probable etiologies via nonpharmacologic
  interventions prior to pharmacological ones.
• Document need for pharmacological treatment
  beyond the presence of symptoms
• Pharmacologic studies design needs to assure
  that
• Studies are conducted with the same population
  for which the drug is to be prescribed
• Studies examine impact on nontarget behaviors