Assessment: Assessing behavior in dementia across cultures

Introduction. Dementia is characterized by cognitive impairment, functional decline, and presence of behavioral and neuropsychiatric symptoms. However, the presence of neuropsychiatric symptoms is not required for a diagnosis of dementia. Only dementia with Lewy bodies and frontotemporal lobar dementia include behavioral and neuropsychiatric symptoms in their definition of diseases. Behavioral and neuropsychiatric symptoms in patients of dementia are increasingly recognized as being important as determinants of patient distress, caregiver burden, quality of life of both patients and caregivers, and outcome of dementia. The frequency and severity of neuropsychiatric disturbances increase in late stage of dementia. It is noteworthy that the prevalence and tolerability of some behavioral and psychological symptoms of dementia (BPSD) depend on environmental, educational, and cultural backgrounds. Apathy is more commonly reported in American than in Chinese patients while wandering and shouting are more tolerated in Australian than in Chinese nursing homes. Terminology and definition. Various terminologies have been used to describe and encapsulate behavioral and neuropsychiatric features in dementia. The term BPSD is commonly used to refer to a heterogeneous collection of psychological problems, psychiatric symptoms, and behavioral alterations in patients with dementia of any cause. The psychological symptoms in BPSD include delusions, hallucinations, misidentification, depression, sleeplessness, and anxiety. Behavioral symptoms in BPSD include physical aggression, wandering, and restlessness. Behavioral and psychological symptoms of dementia include common symptoms that cause distress, and symptoms that are likely manageable (Table 6B.1).