Management of behavior problems in the demented patient

Behavior problems are common in persons with dementia and often lead to caregiver stress and institutionalization for the patient. In most cases, however, these problems are amenable to treatment. Although drug therapy may be necessary to manage some behavior problems, nonpharmacologic strategies may work as well, if not better, with fewer adverse effects. Support and education for the patient's family are the cornerstone of management. At some point, most demented patients display agitation. Appropriate, often nonpharmacologic management of agitation may include establishing a "no-fail" environment, limiting goals and providing reassurance. While delusions and hallucinations are also common, they seldom lead to agitation. Sleep disturbance and wandering are particularly upsetting to the patient's family, but these problems often respond to nonpharmacologic strategies, such as restricting naps and providing more cues about time and place. Depression, which occurs in many demented patients, is an especially treatable cause of disability.