[Behavioral and psychological symptoms of dementia and their management]

The decline in cognitive function is a core feature of dementias. However, other symptoms of the disease are also crucial. These symptoms are the behavioral and psychological manifestations of dementia and include symptoms such as delusions, hallucinations, delusional misindentification syndromes (DMS), illusions, anxiety, aggression, depression, personality changes, disinhibition-impulsivity, violation of social and moral norms, changes in dietary or eating behavior and repetitive behaviors. Delusions, hallucinations, anxiety, depression and aggression are highly prevalent in Alzheimer's disease, vascular dementia and dementia with Lewy bodies, whereas symptoms that include severe disturbance of behavior are highly prevalent in frontotemporal dementias. Psychotic symptoms are associated with subcortical disturbances mainly of the limbic system. Patients with depression present greater loss of noradrenergic cells in the locus coeruleus and loss of serotonergic nuclei of dorsal raphe. Furthermore, disturbances of behavior are associated with frontal lobe dysfunction. Atypical antipsychotics is the first treatment option for delusions, hallucinations, misidentifications, anxiety and aggression. Furthermore, antidepressants may be useful for moderate or severe depression as well as for disinhibition-impulsivity, aggression, changes in dietary or eating behavior and repetitive behaviors. Cholinesterase inhibitors may also improve apathy, anxiety, disinhibition, aberrant behavior, mood disorders and hallucinations. Moreover, non-pharmacological methods alone or in combination with psychotropic drugs may also improve patient's symptomatology.