17 - Treatment of behavioral symptoms in vascular dementia

Summary

Behavioral and psychological symptoms are common in vascular dementia (VaD), and carry a significant burden for patients and carers. The symptoms are divided into those usually assessed at the patient/carer interview and symptoms usually assessed by behavioral observation of the patient/relative. The mechanisms for development of behavioral and psychological symptoms in dementia (BPSD) are unclear. It has been postulated that different factors may operate in Alzheimer's disease (AD) and VaD, suggesting that different treatment strategies may be appropriate for BPSD in different types of dementia. The first line of treatment should usually be non-pharmacological. If the patient is presenting with apparent manic symptoms, agitation or aggressive behavior, it is appropriate to treat with an anticonvulsant. Antipsychotics have been used in the treatment of agitation and non-specific behavioral disturbance in dementia as well as psychotic symptoms. Inhibition of cholinesterase enzymes partially corrects the cholinergic deficit.