By: Houda Hachad, PharmD, M. Res, Vice President of Clinical Operations
Understanding Behavioral and Psychological Symptoms of Dementia
Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, constitute a major component of the dementia syndrome. Nearly all patients with dementia may develop BPSD over the course of their illness. BPSD includes:
- agitation
- aberrant motor behavior
- anxiety
- elation
- irritability
- aggression
- depression
- apathy
- disinhibition
- delusions
- hallucinations
- sleep or appetite changes
BPSD Treatment Options
BPSD is associated with increased costs of informal care and health care costs. The management strategy for BPSD includes a combination of non-pharmacological and, when necessary, the careful use of pharmacological interventions. Pharmacological management of BPSD should be multi-faceted, with non-pharmacological interventions prioritized as first-line treatment. When these are ineffective, short treatments with medications may be used to target specific symptoms, such as agitation, depression, or psychosis.
Pharmacological options for BPSD include:
- antidepressants
- antipsychotics
- sedatives
- hypnotics
- mood stabilizers
- cholinesterase inhibitors
However, their use should be time-limited and closely monitored due to potential harmful adverse effects that may outweigh the benefits in this vulnerable population.
Pharmacogenomic (PGx) testing can be used alongside other therapy management strategies to optimize the use of BPSD medications and minimize the risk of adverse reactions. Additionally, PGx test results can help the care team evaluate deprescribing opportunities, revisit treatment plans, and ensure appropriate polypharmacy.
Dr Hachad is a widely recognized leader in the field of pharmacogenomics and has spearheaded multiple efforts translating scientific requirements into practical technology-based solutions. She has been of the Clinical Pharmacogenetics Implementation Consortium (CPIC) since 2014 and served on the scientific advisory boards of CPIC and the Pharmacogenomics Clinical Annotation Tool (PharmCAT) from 2020 to 2023. She contributes to pharmacogenomics working groups and committees aimed at standardizing pharmacogenomic testing modalities and facilitating their adoption by the clinical community including the Pharmacogene Variation Consortium (PharmVar), the Pharmacogenomics Global Research Network (PGRN), the Association for Molecular Pathology (AMP) PGx Working Group and the STRIPE Collaborative community.
Dr. Hachad has authored numerous peer-reviewed articles, book chapters and evidence-based guideline and standard recommendations in the field of drug-drug interactions and pharmacogenomics
