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35 S I G N Interventions in the Management of Behavioural and Psychological Aspects of Dementia 22 SIGN PUBLICATION NUMBER A Quick Reference Guide Assessment A definitive diagnosis and a clinical, social and functional assessment is essential Consider: psychological state physiological condition social status lifestyle, life history, needs and preferences Non-drug interventions Neuroleptic Drugs Other drug treatments Non-drug interventions should always be considered along with drug options before treatment is started C Non-drug management strategies include: reality orientation behavioural intervention occupational activities environmental modifications validation therapy reminiscence sensory stimulation Neuroleptics have been widely used but evidence for their efficacy is limited There is no clear evidence for the superiority of one neuroleptic drug over any other Side effect profiles differ Neuroleptics should only be considered for patients with serious problems, in particular psychotic symptoms, or in the presence of serious distress or danger from behaviour disturbance C Consider: Antidepressant medication B for marked and persistent depression Short term anxiolytic or C hypnotic treatment for severe and persistent symptoms Evidence for the use of many other described drug treatments for behaviour problems is not sufficient to make recommendations Consent The issue of consent to treatment in the presence of dementia requires careful consideration. Use of the Mental Health (Scotland) Act 1984 may need to be considered Key A B C refers to grade of recommendation C Low doses should be prescribed initially, with slow and cautious increase as necessary: start low, go slow Treatment should normally B be short term and should be reviewed regularly Dose should be reduced B as soon as possible and treatment stopped if no longer essential Neuroleptics should normally be avoided where there is a possibility of Lewy Body type dementia Risk of side effects must be balanced against any perceived benefit Routine use of anticholinergic medication to prevent extrapyramidal side effects is not appropriate B C C Derived from the National Clinical Guideline recommended for use in Scotland by the Scottish Intercollegiate Guidelines Network (SIGN), 9 Queen Street, Edinburgh, EH2 1JQ This Quick Reference Guide was issued in February 1998 and will be reviewed in 2000