Vol 5 n° 1 - Dementia
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lthough cognitive decline and deficits in social competence are the hallmarks of progressive neurode- generation, behavioral abnormalities are common and important characteristics of dementia. Alzheimer’s dis- ease  (AD)  is  the  principal  cause  of  dementia  in  the elderly,1 therefore the following review closely relates to this disorder. It affects almost 15 million people world- wide.1 A wide range of behavioral disturbances afflict the majority of patients with dementia. Behavioral distur- bances, such as verbal or physical aggression, urinary incontinence,  and  excessive  wandering,  are  a  major source of caregiver burden and an important contributor to the decision to admit AD patients to institutionalized long-term care.2,3 The social and psychological skills and the compliance of the caregivers, as well as the presence and competence of the social networkers, determine to a large extent whether a demented patient with behavioral problems can live at home or needs nursing home admis- sion. However, in the past, research in AD focussed pri- marily on the early detection and management of cogni- tive deficits, whereas behavioral disturbances have been neglected.4 Treatment of behavioral problems can improve the qual- ity of life of the patient and the carer, and may help avoid premature institutionalization. The relationship between these disturbances and the severity of dementia has not been clarified.There is some evidence that some symptoms such as depression and anxiety are more common during slight to moderate stages,  whereas  others,  eg,  behavioral  problems  like aggression, seem to occur more in advanced dementia. In severe stages, significant cognitive impairment becomes predominant and some behavioral dysfunctions get grad- Keywords: dementia; depression; anxiety; agitation; psychosis; aggression; disinhibition; Alzheimer’s disease Author  affiliations:  Psychiatric  Hospital  of  the  University  of  Basel,  Basel, Switzerland Address   for   correspondence:   Prof   Dr   med   Franz   Müller-Spahn,   Medical Director, Psychiatrische Universitätsklinik, Wilhelm Klein-Strasse 27, CH-4025 Basel, Switzerland (e-mail: franz.mueller-spahn@pukbasel.ch) C l i n i c a l   r e s e a r c h 4 9 Behavioral disturbances in dementia Franz Müller-Spahn, MD A Psychological symptoms and behavioral abnormalities are common and prominent characteristics of dementia. They include symptoms such as depression, anxiety, psychosis, agitation,  aggression,  disinhibition,  and  sleep  distur- bances.  Approximately  80%  to  90%  of  patients  with dementia suffer from such behavioral disorders. There are complex interactions between cognitive deficits, psycho- logical symptoms, and behavioral abnormalities. A large number  of  standardized,  reliable,  and  well-validated instruments for assessing the behavioral and psychologi- cal symptoms of dementia have been developed in order to evaluate the efficacy of treatment. Neurodegenerative processes in various brain areas, particularly in the fronto- temporal cortex and limbic regions, leading to choliner- gic, serotonergic, and noradrenergic neurotransmitter dys- functions constitute the biological matrix of behavioral symptoms, whereas psychological factors and personality traits play a modifying role. A large number of pharma- cological,  psychoeducational,  psychotherapeutic,  and social strategies have been developed to improve the quality of life of patients and their caregivers. Dialogues Clin Neurosci. 2003;5:49-59.