Drugs for behavioral and psychological symptoms

3. Non-drug approaches

Although everyone should be treated individually, it can be helpful to take a consistent approach that follows the same broad steps. The underlying principle is that behavioural and psychological symptoms should be seen as a sign of distress or an attempt to communicate an unmet need, such as being in pain or feeling threatened.

The challenge is to work out the unmet need that lies behind the person’s distress, and then find a way to address this. This will mean looking at the person as an individual and thinking about their personality, history, likes and dislikes.

If you are caring for someone and they go into hospital or a care home, staff may ask you to complete a form on their behalf such as Alzheimer’s Society’s This is me. This form lists a person’s history, preferences and routines. It can help staff know the person better and help work out what might be causing the person’s distress. For more go to alzheimers.org.uk/thisisme

The first step is to find out whether any underlying physical or medical factors may have triggered the person’s symptoms or may be aggravating them (making them worse). For this reason, if a person with dementia develops behavioural and psychological symptoms, they should have an assessment by their GP at the earliest opportunity.

The doctor should look for conditions such as pain, infection, constipation or the side effects of medication. If any of these are found, the doctor should try to manage them appropriately. If a mental health problem (such as depression or anxiety), is identified, treatment can be offered. For more on this see Apathy, depression and anxiety.

It is important to make sure that the person with dementia is comfortable (for example, not thirsty or hungry) and well cared for. If the person has a hearing aid or glasses, these should also be checked. If they are not being worn or are not working properly, this can contribute to confusion and misperceptions, and can cause the person distress.

The next step is to consider the person’s environment to make sure it is not too noisy, too bright or cluttered. These can all cause the person to become over-stimulated and agitated.

Some behaviours will be a response to a specific event, perhaps an offer of personal care (such as help to undress) that was misunderstood. Keeping a diary of when behaviours happen, and what was going on at the time, may show a pattern and in doing so suggest a solution.

A person’s behavioural and psychological symptoms often lessen if they are helped to stay active and stimulated. Finding interesting and engaging daily activities that are matched to the person’s abilities can help. These could include arts and crafts, reminiscence or anything else that is meaningful for the person. By doing this, it is often possible to avoid the use of drugs altogether.

If a person with dementia develops any of these changes, it is important to remember that they are not to blame or ‘behaving badly’. Their symptoms may be a direct result of changes in their brain, or because of a general health problem such as discomfort caused by pain or infection. These symptoms can also be related to the care a person is receiving, their environment or how they are spending their time.

Simple things such as social interaction can also prevent the need for drugs. For example, research suggests that some symptoms can be reduced by just 10 minutes of one-to-one time each day. When communicating, it is important to listen carefully to the person, look for non-verbal cues (such as facial expressions and body language) and try to understand the reality they are experiencing. For more on communicating with a person with dementia see factsheet 500, Communicating.

Other examples of non-drug approaches that may help include life story work, physical exercise, music, dance and hand massage. For more information see factsheets 509, Dementia and aggressive behaviour, and 529, Exercise and physical activity.

If these general approaches do not work, more specialist advice may be needed. For more specialised non-drug approaches this could mean referral to a clinical psychologist, or perhaps to a music therapist or speech and language therapist. These professionals should develop a care plan created specifically for the person.