Behavioral and psychologic symptoms of dementia

[Zipporah Schumaker]

Disruptive actions are common among patients with dementia and are the primary reason for up to 50% of nursing home admissions. Disruptive actions include wandering, restlessness, yelling, throwing, hitting, refusing treatment, incessantly questioning, disrupting work of staff members, insomnia, and crying. Behavioral and psychologic symptoms of dementia have not been well characterized, and their treatment is poorly understood.
Deciding what actions constitute a behavioral symptom is highly subjective. Tolerability (what actions caregivers can tolerate) depends partly on the patient’s living arrangements, particularly safety. For example, wandering may be tolerable if a patient lives in a safe environment (with locks and alarms on all doors and gates); however, if the patient lives in a nursing home or hospital, wandering may be intolerable because it disturbs other patients or interferes with the operation of the institution.
Many behaviors (eg, wandering, repeatedly questioning, being uncooperative) are better tolerated during the day. Whether sundowning (exacerbation of disruptive behaviors at sundown or early evening) represents decreased tolerance by caregivers or true diurnal variation is unknown. In nursing homes, 12 to 14% of patients with dementia act disruptively more often during the evening than during the day.
(See also Overview of Delirium and Dementia and Dementia.)