BPSD

Question 1

List 7 non-pharm management of BPSD?

Answer 1

Interdisciplinary approach
Music therapy
Massage therapy
Robotic pets
Animal therapy
Physical exercise
Aromatherapy

Question 2

List 4 second line pharm management of BPSD?

Answer 2

Quetiapine
Haloperidol (2-6 mg/d)
Nabilone
Carbamazepine

Question 3

10 BPSD behaviours that do NOT involve psychosis/affective symptoms

Answer 3

Arguing
Hoarding
Pacing
Wandering
Rummaging
Rejection of care
Worrying
Shadowing (following caregiver)
Socially inappropriate behaviour
Sexually inappropriate behaviour
Waking at night

Question 4

4 ways to identify pain in a patient with severe dementia

Answer 4

-Facial expressions (grimacing, brow lowering, closed eyes, wincing, mouth opening)
-Vocalisations/verbalizations (moaning, groaning, grunting, crying, oww, gasping)
-Body movements (flinching, thrashing, rocking, bracing, rubbing, limping, clenched fists, shaking)
-Changes in interpersonal interactions (not wanting to be touched, decreased interaction, difficult to console)
-Change in activity patterns/ routines
Mental status change

Question 5

12 components of the NPI?

Answer 5

delusions
hallucinations
agitation/aggression
depression/dysphoria
anxiety
elation/euphoria
apathy/indifference
disinhibition
irritability/lability
aberrant motor behaviour
sleep and nighttime behaviours
appetite changes

Question 6

List 8 communication strategies for patient with agitation

Answer 6

Use the person’s name
Speak slowly and clearly
Use simple sentences
Ask yes/no questions
Use one step instructions
Use positive statements
Avoid arguing
Accept different perceptions of time and reality
Avoid confrontation or correction.
Reassurance, distraction, and validation of the person’s feelings

Question 7

List 10 ways to tell a caregiver how to manage wandering

Answer 7

-Look for pattern
-Keep objects associated with the outdoors (car keys, jackets, shoes) out of the person’s view
-Re-locate door locks above eye level or where the person can’t see them
-Try disguising doors
-Alarms
-Door mats that set off an alarm when stepped on
-Engage in regular physical activity
-Tell neighbours, nearby businesses and your local police

Question 8

2 categories of wanderers

Answer 8

Random wandering (moves aimlessly with no apparent goal, often in response to anxiety or physical discomfort)

Goal directed wandering (purposeful, often in response to a concern/worry or past obligations such as going to work or making supper)

Question 9

Pharm management of apathy?

Answer 9

Methylphenidate 5mg PO daily
Modafinil - no significant difference

Question 10

4 features of the Charles Bonnet syndrome

Answer 10

Well formed

Vivid, elaborate

Often stereotyped visual hallucinations

Maintain insight that the hallucinations are not real

Visual hallucination only

Question 11

5 causes of tardive dyskinesia

Answer 11

antipsychotics
antiemetics
antiepileptics
antidepressants: trazodone, fluoxetine, doxepin, clomipramine, amitriptyline
lithium
MOAB-i

Question 12

2 non-pharm and 3 pharm treatments of tardive dyskinesia?

Answer 12

Non-pharm:
1. Stop offending agents (works in 13%)
2. DBS (globus pallidus/STN)

Pharm:
1. Valbenazine (VMAT2) / tetrabenazine (VMAT2)
2. Clonazepam
3. Amantadine

Question 13

4 risk factors that predispose towards hoarding behaviour in an older adult

Answer 13

Social isolation
Past trauma
Depression and anxiety, Personality disorders, PTSD
Cognitive deficits (memory, attention, executive function)
Substance use disorders

Question 14

6 actions you can take to help family of patient with BPSD?

Answer 14

Referral to Behaviour Support Outreach Team

Psychosocial and psychoeducational interventions for caregivers (CCCDTD5)

Connection to organizations for dementia for resources and support (e.g., Alzheimer Society) (CCCDTD5)

Case management (CCCDTD5)

Connection to homecare services

Referral to adult day programs and other respite programs

Question 15

4 domains of Mild Behaviour Impairment (MBI)

Answer 15

IDEAS

1) impulse dyscontrol
2) decreased motivation
3) emotional dysregulation
4) abnormal perception or thought content
5) social inappropriateness

Question 16

What is a validated tool for MBI?

Answer 16

MBI Checklist (Ismail 2017)

Question 17

What is the relative risk for mortality with the use of atypical antipsychotics for BPSD? Other than stroke and mortality, what are three other risks associated with their use?

Answer 17

Mortality RR: 1.6 (1.5-2)

EPS, NMS, sedation, weight gain

● Olanzapine RR = 2.31
● Aripiprazole RR = 1.99
● Quetiapine RR = 1.86
● Risperidone RR = 1.35

Question 18

6 triggers for new-onset BPSD that are not disease- or medication-related

Answer 18

1. undiagnosed medical conditions
2. change in routine/environment
3. environmental understimulation
4. change in care partner style/tone
5. sensory impairment
6. Pain, thirst etc.