<p> Management Checklist for Behavioural Symptoms of Dementia</p><p>Name……………………………. D.O.B……………………………….. Date of Assessment…………………..</p><p>Management should focus around early recognition and prevention of behavoural symptoms of dementia, using assessment and non drug management. Antipsychotics should only be prescribed as a last resort and for a defined length of time. The need for ongoing antipsychotic treatment should be assessed by specialist services. Medical Review . Dehydration: assess fluid intake, constipation . Pain: Assess for any possible causes of pain. . Infection: especially UTI, chest infection Medication Review . Medication: avoid polypharmacy, codeine, anticholinergics including tricyclic antidepressants, oxybutinin, long acting SSRIs. . Be aware of possible serotonergic syndrome, drug induced delirium. Clinical Review . Delirium & confusion : treat according to guidance. . Known Neuropsychiatric symptoms . Depression: 4GDS >2 – treat appropriately-see local depression guidelines Person centred care . Environmental factors . Assess severity of symptoms . Address factors that may influence behaviour MILD TO MODERATE SYMPTOMS SEVERE SYMPTOMS EXTREME RISK OR Refer any patient refusing to eat/drink DISTRESS or needing restraint WATCHFUL WAITING / NON DRUG TREATMENTS ASSESS & document baseline: Severe distress / Document symptom / incident, triggers and tried o CVA risk Cognition Risk of harm to self or intervention in individual care plan and review o Target symptoms others regularly with carers/ staff . BADCHAVS tool. o Co morbid conditions Notes : Interventions should be tailored to the o Carer consent individual and may include: CBT /psychosocial therapy, diversion, reorientation, multisensory RISK - BENEFIT documented & TARGET SYMPTOMS identified stimulation & other simple interventions (e.g. if If antipsychotics contra indicated, (e.g. stroke, Lewy Body hungry, in pain etc.) dementia) or ineffective, contact Older Persons Mental Health Review progress regularly - If symptoms worsen, team for advice. unsuccessful then consider specific interventions including psychosocial interventions / drug Severe agitation or psychosis (with aggression): Start with a low therapies. dose antipsychotic & titrate up according to response: 1st choice: Risperidone 250 microgram bd to max 1mg bd 2nd choice : Olanzapine 2.5mg od to bd PSYCHOSOCIAL interventions: tailor activities to Review at 6 weeks and / or every 12 weeks: individual needs & document in care plan. 1. Assess response: improvement in severity of symptoms. PHARMACOLOGICAL therapies 2. Monitor side effects: cognitive decline, target behaviour, weight gain, BP drop / dizziness, glucose levels, EPSE, Analgesia: Paracetamol 1g up to qds sedation, constipation, fluid intake, signs of (chest) Mild to moderate agitation: infection. Lorazepam 0.5mg to 1 mg up to qds (short term) 3. Reduce dose: If patient symptoms have improved and Trazodone 50 to 300mg daily stable for 3 to 6 months reduce the dose by 50% every 2 Depression: Sertraline 50 to 100mg daily weeks with continued monitoring and then stop. Citalopram 10 to 20 mg OD 4. Unless there is severe risk or extreme distress, the Sleep Disturbance: Zopiclone 3.75 to 7.5mg nocte recommended default management is to discontinue the antipsychotic and continue to monitor/assess. Temazepam 10mg nocte 5. Where continued antipsychotic treatment is clinically Mood stabiliser: Carbamazepine 50 to 300mg daily necessary, referral to specialist services is advised. 6. Set next review date with ongoing management plan. Any other Comments:</p><p>Alzheimer’s SOCIETY. Optimising treatment and care for people with behavioural and psychological symptoms of dementia</p>