Behavioral and Psychological Symptoms of Major Neurocognitive Disorders

Behavioral and psychological symptoms of dementia (BPSD) or of major neurocognitive disorders (MND) are a group of noncognitive symptoms and behaviors seen commonly among individuals with dementia. BPSD results in increased morbidity and mortality among individuals with dementia. It is also associated with greater caregiver burden and burnout and higher cost of caring for individuals with dementia. BPSD is thought to occur due to an interplay between the various biological, psychological, social, and environmental factors. A comprehensive assessment of BPSD includes a thorough history, mental status examination, focused physical examination, and appropriate laboratory investigations. The use of standardized assessment tools like the Neuropsychiatric Inventory (NPI) will help with qualifying and quantifying the symptoms of BPSD. Current evidence indicates that non-pharmacological and pharmacological interventions are beneficial in the treatment of BPSD. Non-pharmacological interventions are recommended as the first-line treatments for BPSD. Pharmacological management is used in the treatment of more severe or refractory BPSD or in situations where non-pharmacological interventions are not feasible. In this chapter, we review the evidence for the use of both non-pharmacological and pharmacological interventions in the treatment of BPSD.