Typical consult question “A seventy-two year old man with a history of Parkinson's disease is admitted to the hospital for placement because his family ‘can't handle him anymore.’ The patient has been paranoid and frequently refuses medications. Please help us with management.” Background Dementia is an increasingly frequent and costly disease of our aging population. An estimated 5% to 15% of the U.S. population over the age of 65 has dementia. Worldwide estimates are 25 million with an expected doubling by 2020. Neuropsychiatric symptoms occur in more than 80% of those with Alzheimer's disease (AD). Symptoms may include mood disorders, sleep disturbance, irritability, aggression, psychosis, and agitation. Behavioral and mood disturbances in patients with dementia are associated with patient and caregiver distress, greater impairment in activities of daily living (ADLs), decreased cognition, increased care costs, and nursing home placement. Among the most troubling neuropsychiatric symptoms is agitation, found in 40% to 60% of nursing home patients with AD. Similar rates of agitation and psychosis have been found in patients with vascular dementia. Cohen-Mansfield (2001) delineated several categories of “inappropriate behavior” associated with dementia, summarized as follows: Physically aggressive behaviors (e.g., hitting, kicking, biting) Motoric restlessness that is not aggressive (e.g., pacing, repetitive mannerisms) Verbalizations (e.g., perseverations, cursing, screaming) Agitation in patients with dementia may present acutely, follow a “waxing and waning” course, or develop slowly over months to years.
|Original language||English (US)|
|Title of host publication||Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry|
|Publisher||Cambridge University Press|
|Number of pages||11|
|State||Published - Jan 1 2010|
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