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IPA Bulletin

Behavioral and Psychological Symptoms of Dementia (BPSD): A Clinical and Research Update

BPSD has become an area of increasing scientific and societal interest, as these symptoms diminish quality of life for both the patient and care giver, and increase hospitalization, rates of institutionalization, and financial hardship. Clinical activity and research in behavioral and psychological symptoms of dementia (BPSD) have increased substantially since IPA’s 1996 Consensus Conference on this topic. In fact, there has been so much activity that “Behavioral and Psychological Symptoms of Dementia (BPSD): A Clinical and Research Update” was held in May 1999 to report on the considerable progress in the field during the past three years. Developments in nosology, etiology, phenomenology, diagnosis and assessment, pharmacological and non-pharmacological treatment and management, cross-cultural and transnational considerations, and regulatory issues related to BPSD were among the issues that were enthusiastically described and discussed.

Chaired by Sanford I. Finkel and Alistair Burns, and sponsored by an unrestricted grant from Janssen Pharmaceutica and Janssen-Cilag and Organon, the Conference brought together 60 experts from 17 countries who were invited to present the most salient findings in the field of BPSD since 1996. In addition to Drs. Finkel (US) and Burns (UK), Gene Cohen (US) and Eric Caine (US) served as facilitators. Moderators included Martin Haupt (Germany); Akira Homma (Japan); Peter Whitehouse (International Working Group of Harmonization of Dementia Drug Guidelines, USA); and Michael Zaudig (Germany).

With presentations limited to 10 minutes each, an extraordinary amount of material was shared in a short, but intense, meeting of less than three days’ duration, held outside Washington, DC, in Lansdowne, Virginia. In an open discussion following the presentations, participants sought to reach consensus and recommendations based on information currently available about BPSD, as well as to propose an agenda for future research and policy decisions.

This Clinical and Research Update conference exemplifies one of the ways in which IPA works to fulfill its mission: to provide information about behavioral and biological aspects of geriatric mental health, promote research and education, and facilitate international consensus on psychogeriatric issues.

By this cross-fertilization of ideas and inter-disciplinary collaboration, the 1999 Update findings will be of long-term benefit to professionals, patients, and caregivers. An overview of the conference and summaries of the papers presented will be published later this year in a special issue of International Psychogeriatrics. Look for a comprehensive report on this conference in the next issue of the IPA Bulletin.

BPSD: A Clinical and Research Update May 11-13, 1999
Presentations
Perspectives of BPSD
Introduction	S. Finkel (USA)
Overview and Direction for the Conference	B. Lebowitz (USA)
BPSD in DSM IV and beyond	E. Caine (USA)
BPSD in ICD 11	M. Zaudig (Germany)
Epidemiology of BPSD	D. O’Connor (Australia)
BPSD and quality of life	P. Rabins (USA)
BPSD in nursing home residents: economic implications	J. O’Brien (USA)
How do BPSD predict institutionalization?	G. Grossberg (USA)
Are BPSD associated with mortality?	D. Gilley (USA)
The importance of BPSD in primary care	W. Coleman (USA)
Etiology
Neuropathology of BPSD	H. Förstl (Germany)
The contribution of genetics to understanding BPSD	C. Holmes (UK)
The impact of the environment on BPSD	S. Eriksson (Sweden)
The impact of BPSD on caregivers	C. Ballard (UK)
The impact of personality on BPSD	W. Meins (Germany)
Phenomenology
Delusions and hallucinations	S. Holroyd (USA)
Physical aggression and catastrophic reactions	I. Katz (USA)
Physical non-aggressive agitation	M. Haupt (Germany)
Depression in BPSD	F. Verhey (Netherlands)
Apathy and withdrawal	S. Starkstein (Argentina)
Anxiety in BPSD	J. Mintzer (USA)
Circadian rhythms and BPSD	D. Bliwise (USA)
What are the syndromes of BPSD?	R. McShane (UK)
Is BPSD a distinct syndrome?	B. Reisberg (USA)
What is the relationship between cognition and BPSD?	G. Swanwick (Ireland)
Diagnosis/Assessment
What has changed in clinical assessment of BPSD?	M. Trabucchi (Italy)
New and promising assessment modalities	I. Monteiro (USA)
Neuroimaging	J. Luxenberg (USA)
BPSD and Frontal Lobe Dementia	A. Kertesz (Canada)
BPSD and Lewy Body Dementia	I. McKeith (UK)
BPSD and Vascular Dementia	T. Erkinjuntti (Finland)
BPSD and Delirium	J. Lindesay (UK)
What are the necessary characteristics of a BPSD rating scale?	A. Shah (UK)
Pharmacological approaches: what is the role of medication in the treatment of BPSD?
What are the characteristics of the ideal drug for BPSD?	D. Jeste (USA)
Brain morphologic and neurochemical correlates of depression in Alzheimer’s disease	G. Zubenko (USA)
Cholinergic contributions to BPSD	T. Sunderland (USA)
Anti-convulsants	P. Tariot (USA)
SSRIs and Trazodone in the treatment of BSPD	D. Sultzer (USA)
Conventional neuroleptics in the treatment of BPSD	D. Devanand (USA)
Risperidone in the treatment of BPSD	P. De Deyn (Belgium)
Other novel anti-psychotics	M. Davidson (Israel)
Anxiolytics in the treatment of BPSD	H. Allain (France)
Hormonal treatments for BPSD	G. Small (USA)
What has changed in clinical trials of BPSD?	S. Finkel (USA)
Do we need a meta-analysis update?	L. Schneider (USA)
Regulatory Issues
This component organized by the International Working Group of Harmonization of Dementia Drug Guidelines (IWG)
Regulatory Issues on BPSD – an Overview	P. Whitehouse (USA)
Regulatory Issues on BPSD in Europe	I. McKeith (UK)
Regulatory Issues on BPSD in Japan	A. Homma (Japan)
Regulatory Issues on BPSD in the USA	T. Laughren (USA)
Non-pharmacological management and treatment
Impact of caregiver interventions and support groups on BPSD	M. Mittelman (USA)
Caregiver burden	A. Burns (UK)
Application of psychosocial interventions for treating BPSD	L. Burgio (USA)
Music, art, and recreation therapies in the treatment of BPSD	L. Gerdner (USA)
Day care centers in the management of BPSD	N. Jorgensen (Spain)
The use of patient characteristics to determine non-pharmacologic interventions	J. Cohen-Mansfield (USA)
Combined therapy: an overview	L. Teri (USA)
Cross-cultural and trans-national issues
Translations of measurements and scales: opportunities and diversities	S. Auer (Germany)
Racial differences in BPSD	C. Cohen (USA)
BPSD in Africa and the Caribbean	H. Hendrie (USA)
BPSD in Eastern and South Eastern Europe and the Middle East	E. Eker (Turkey)
BPSD in Latin America	C. Mangone (Argentina)
BPSD in Japan and the Asian Pacific Region	A. Homma (Japan)

Reprinted from IPA Bulletin, Volume 16, Number 2