An effective option for managing behavioural problems

Most older people with dementia at some point in their illness develop psychiatric symptoms or behavioural disturbances such as agitation, aggression, depression, delusions, wandering, sleep disturbance, and hallucinations. Collectively, these are termed behavioural and psychological symptoms of dementia.1 They are frightening for patients and their carers; constitute a major management problem for psychiatrists, general practitioners, and geriatricians; and act as a trigger for admission to institutional care. After excluding treatable causes such as concurrent infections, non-pharmacological approaches such as behavioural management are the recommended first line intervention.2

In practice, however, drugs such as neuroleptics and other sedatives are often prescribed in an attempt to control what can be an alarming situation. Although neuroleptics have modest term efficacy in the short term,3 they are associated with side effects such as sedation, extrapyramidal signs, falls, a …