Abstract
This small and concise text is a welcome addition to the burgeoning literature on the treatment of behavioural and psychological symptoms in dementia (BPSD). This ‘cinderella’ aspect of dementia has only really been recognized as a major source of patient distress, carer burden and early institutionalization over the last one to two decades. The authors particularly note in their review of relevant studies that the evidence base for many of the management strategies in the area is sparse, and there is a need for methodologically sound studies to establish treatment guidelines.
As well as a description of the frequency and types of BPSD, and their relationship to particular subtypes of dementia, there is a very useful chapter on evaluation. The most common rating scales, which have been developed to assess the spectrum of psychiatric symptomatology associated with dementia, are critiqued as to their reliability and clinical and research usefulness. Each rating scale is fully set out in table form, enabling the reader to quickly and easily compare the number and content of the items, and the practicability of administration.
The text encompasses a broad perspective of the area with separate chapters reviewing the current understanding of the neurobiological basis of BPSD, as well as the issue of caregiver burden, which is now recognized as being more associated with this aspect of dementia than actual cognitive decline.
Management is typically addressed in terms of nonpharmacological and pharmacological strategies, with the authors emphasizing the importance of targeting particular symptoms or behaviours, and the need to be mindful of the fluctuation that is usually characteristic of these phenomena. Although they advocate that behavioural interventions are generally preferred first-line treatment, they also caution that there has, to date, been sparse systematic investigation of this area. The research database on pharmacological interventions is more substantial but most treatment studies have concluded that response rates are modest and patients with dementia are particularly sensitive to side-effects of psychotropic medications. The final chapter of the book summarizes recommended first-line treatments for particular clinical situations, and a useful algorithm for pharmacological treatment of BPSD is provided.
Overall, I consider that this relatively brief text would be useful for all clinicians, psychiatric and non-psychiatric, who manage patients with dementia. It does not replace more in-depth reviews of the area, but its conciseness and overview of the evidence base for current treatment strategies is particularly advantageous in the clinical setting. Of note, some recommended medications are not available in Australia, but this only minimally limits the usefulness of the treatment guidelines as similar available agents can be readily substituted.