Historical trends in neuropsychiatric symptoms

Key points

Neuropsychiatric symptoms like agitation and psychosis occur in up to 90% of people with dementia and often change over time.
Historical trends show that people are now diagnosed earlier, but the types of symptoms remain similar; early intervention is key.
Always rule out medical causes (like infection or pain) before assuming a behavior is dementia-related.
Non-drug approaches (routine, environment changes, redirection) should be tried first before considering medication.
If medication is needed, use atypical antipsychotics at low doses, with regular reviews and a plan to taper if possible.
Caregiver stress is a major factor; taking care of yourself helps both you and the person with dementia.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Validate the person's reality without correcting inaccuracies (e.g., if they say it's morning at night, say 'Let's have a cup of tea' rather than 'It's nighttime')
Use short, positive, one-step commands (e.g., 'Put your hand here' rather than 'Now take your arm and put it there')
Maintain a consistent daily routine for sleep, meals, and bathing to reduce confusion
Ensure home safety by removing tripping hazards, locking away dangerous items, and using nightlights
Engage with simple, familiar activities from the person's past (e.g., folding laundry, sorting photos) to provide comfort
Anticipate pain or discomfort (e.g., check for hunger, thirst, bathroom needs, or full bladder) before responding to agitation
Use the person’s preferred name and speak in a calm, unhurried voice
Redirect distractions or repeated questions by offering a specific alternative (e.g., 'Let's look at this book together' instead of answering the same question again)

Never argue, contradict, or correct a person with dementia regarding time, place, or identity
Do not ask open-ended questions like 'What do you want to eat?' that require complex decision-making
Do not use baby talk, scold, or raise your voice
Do not overwhelm with multiple tasks or steps at once
Do not force the person into an activity if they resist; drop it and try later
Do not leave the person unsupervised in unsafe areas like the kitchen or bathroom without adaptations

Simplified clothing set
Provide clothes with fewer fasteners (e.g., elastic waistbands, Velcro closures, slip-on shoes) to maintain independence and reduce dressing frustration
Visual cues board
Use a whiteboard with pictures (e.g., a cup for drink, a door for outdoors) to indicate daily events and reduce repeated 'what's happening' questions
Bathroom sensor mat
Place a pressure-sensitive mat that chimes when stepped on near the bed or bathroom to prompt bathroom use and prevent falls during nighttime wandering

Ask your doctor: 'Could a urinary tract infection or other medical condition be causing my loved one's sudden agitation or psychosis?'

Ask your doctor: 'What are the risks and benefits of starting an antipsychotic medication for this person, given their age and dementia type?'

Ask your doctor: 'How often should we review the need for this medication? Can we try a gradual reduction after a few months?'

Ask your doctor: 'Are there any drug interactions with the current medications that could be worsening these symptoms?'

Ask your doctor: 'What non-drug strategies have been proven effective for agitation in dementia, and can you refer me to a specialist or program?'