Many of dementia's behavioral symptoms can be managed well, without medications, if physicians integrate behavioral management strategies into early, ongoing treatment, according to Johns Hopkins University School of Nursing professor, Laura N. Gitlin, PhD; Johns Hopkins School of Medicine professor and Alzheimer's researcher, Constantine G. Lyketsos, MD, MHS; and Helen C. Kales, MD, University of Michigan associate professor and research scientist at the VA Center for Clinical Management Research.
In "Nonpharmacologic Management of behavioral Symptoms in Dementia," a special "Clinician's Corner" published Nov. 21 in the Journal of the American Medical Association, the authors outline a 6-step approach to help clinicians identify and effectively manage most behavioral symptoms of dementia.
1. Screen for behavioral symptoms early.
2. Identify symptoms.
3. Delineate the triggers and risk factors for the symptoms.
4. Choose the proper interventions.
5. Evaluate the intervention to make sure that it's working.
6. Follow the patient's progress over time.
"This six-step process should be a routine part of regular healthcare for individuals with dementia," observes Gitlin, who directs the JHUSON Center for Innovative Care in Aging. "It should be undertaken in any clinical setting involved in caring for someone with dementia, including primary care and memory clinics, as well as in hospitals, assisted living and nursing facilities."
For example, an individual with dementia might wake repeatedly each night, voicing fear of being alone in the dark, despite continuous calming efforts. An intervention might mean simply using a nightlight in the patient's room, or adding long family walks in the evening, to help promote better sleep.
Clinicians play a key role by educating families and caregivers about dementia, and about its behavioral symptoms, including why they occur, the authors say.
Clinicians also can provide tools and strategies to help caregivers prevent challenging behavioral symptoms. To reduce a patient's confusion and disorientation, for instance, a caregiver might be encouraged to break daily activities into small, simple steps and to establish structured routines. Low-tech interventions like these can reduce symptoms and unnecessary healthcare costs related to urgent visits to hospital emergency departments.
"Broad application of this systematic, uniform approach can advance both clinical practice and the development of new pharmacologic and nonpharmacologic therapies for these most challenging symptoms of dementias," Lyketsos notes.
"Given the limitations and risks of current pharmacologic treatments, increasing the uptake of evidence-based non-pharmacologic treatments is imperative," Kales adds.