Regarding the psychobehavioral symptoms of AD, these 5 points should be clarified

* For medical professionals read reference Zhibi have for early detection and wisdom
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September 21, 2021 is the 28th World Alzheimer's Day.
The theme is "Know Dementia, Know Alzheimer's"-Knowing the enemy and knowing the past The Alzheimer's Disease Branch (ADC) of the Health Care Association planned a series of expert interview activities.
This issue specially invited Professor Wang Huali from the Sixth Hospital of Peking University
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We know that in addition to cognitive impairment symptoms in Alzheimer's disease (AD) patients, psycho-behavioral symptoms are another major group of symptoms
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So, in clinical practice, what aspects need to be paid attention to for the mental and behavioral symptoms of AD? Let’s take a look~ There are many symptoms.
Professor Wang Huali introduced during the whole illness.
The psycho-behavioral symptoms of AD have a professional term in the field of cognitive science-BPSD, Behavioral and psychological symptoms of dementia, that is, the group of mental and behavioral symptoms of dementia
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BPSD can be seen in many types of dementia such as AD, dementia with Lewy bodies, and frontotemporal dementia
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Called symptom clusters is included because the symptoms varied, such as emotional problems: depression, anxiety and so on; psychotic symptoms: hallucinations, delusions and so on; there are behavioral problems: agitated behavior, impulsive behavior
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Different types of dementia have different characteristics of BPSD.
For example, patients with Lewy body dementia are more prone to visual hallucinations
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BPSD is not unique to AD, but it is very common for AD patients to have psychobehavioral symptoms
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It is reflected in two aspects.
One is the high incidence.
Foreign studies have shown that up to 96% of AD patients in the memory clinic show at least one psychobehavioral symptom [1]; the second is that psychobehavior symptoms can occur at any stage of AD , Psycho-behavioral symptoms are not a patent for patients with advanced AD
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Professor Wang Huali emphasized that at any stage of the AD disease process, attention should be paid to mental behavior problems, and attention should be paid to the characteristics of mental behavior symptoms at different stages.
For example, emotional problems may be more prominent in the early stage, while psychotic symptoms and behavior problems in the middle and late stages are more obvious.
For example, it is often seen that patients have hallucinations, beatings, etc.
; changes in mental behavior symptoms may correspond to the development of the severity of the disease
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Professor Wang Huali’s team has studied the mental and behavioral symptoms of AD patients in the memory clinic, and the results suggest that the mental and behavioral symptoms of AD patients with poor cognition and ability of daily living are more serious [2]
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Asking carefully will identify the mental and behavioral symptoms of AD patients.
Young doctors are very concerned about how to inquire in clinical practice and obtain effective clinical data
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Professor Wang Huali taught her experience: learn to identify and refine standard medical terms from family members’ descriptions
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The symptom nouns that family members tell doctors are often not standard medically expressed symptom nouns.
It is necessary to understand the meanings expressed by family members and correspond to the standard medical terms used in medicine one by one
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Young doctors should pay attention to exercise this ability.
In addition to accurately understanding the symptoms, they should also pay attention to asking about the reasons for these symptoms, clues, and the effects of measures taken by family members.
You can't just ask about symptoms based on symptoms
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Comprehensive and in-depth questions will be of great help to subsequent diagnosis and treatment
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Early identification and early management of AD patients’ psycho-behavioral symptoms are based on biological factors.
Changes in brain structure and function can make patients more sensitive to the triggering factors of some psycho-behavioral symptoms
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Patients, environment, and caregivers are the other three factors that cause psychobehavioral symptoms
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Professor Wang Huali pointed out that the caregiver factor cannot be ignored
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If the caregiver does not understand the care skills and the communication between the patient and the caregiver that the patient wants to express, it is easy to induce the patient's mental behavior symptoms
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Recognizing these factors that may change in time and making adjustments are beneficial to prevent or reduce the mental and behavioral symptoms of AD patients
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Non-drug, first-line non-drug treatment is the first-choice treatment for AD mental and behavioral symptoms
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As mentioned in the previous article, clinicians need to find out the factors causing psychobehavioral symptoms in patients in time and deal with them appropriately
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In 2017, the "Expert Consensus on Clinical Diagnosis and Treatment of Neurocognitive Disorders and Mental Behavior Symptoms" formulated by the Geriatric Psychiatry Group of the Psychiatric Branch of the Chinese Medical Association and written by Professor Wang Huali was released [3]
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The guidelines recommend that the management of BPSD patients adopt a process of Describe-Investigate-Investigate-Create-Evaluate the effect (Evaluate), called DICE
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For example, Professor Wang Huali, the patient has had a lot of tantrums recently, and his family members found that they lack patience and tone when communicating with the patient.
When the family members changed the way of communication and the speech became milder, the patient’s tantrums decreased.
This is a way to find the cause and solve it.
The way of the problem
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Of course, the way to improve may be verbal or action, and sometimes it may require some more complex intervention methods
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Professor Wang Huali expressed in the interview that he hopes that the majority of doctors will realize that it is not necessary to prescribe drugs to treat the psychobehavioral symptoms of AD; although the outpatient clinic is fast, it is still recommended to communicate with patients and family members more.
It makes sense to spend more time, thought, and patience
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Able to balance, and many patients with AD have psycho-behavioral symptoms.
According to the guidelines, psychotropic drugs should be used in the following situations: (1) major depressive episodes with or without suicidal ideation; (2) causing harm or having the potential for great harm Psychotic symptoms; (3) aggressive behavior that poses a risk to the safety of oneself and others
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Professor Wang Huali emphasized that medication should start with a small dose to ensure safety
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Seeking a balance between efficacy and safety, every doctor has his own wisdom
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In addition, you need to spend some patience, learn more about the patient and family members, and you may need more time to visit the clinic
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Moreover, AD is a type of interdisciplinary disease, and it is also a type of disease that requires cooperation from multiple disciplines.
It may be tricky to handle AD with mental and behavioral symptoms, and referral is recommended if there are doubts
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For psychiatrists, who have received professional training such as psychotherapy, they should give full play to their professional advantages in the process of diagnosis and treatment
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For grassroots doctors, especially psychiatrists, they are encouraged to pay attention to checking the cognitive function of patients in the process of diagnosis and treatment of the elderly, so that it is possible to find those patients with dementia who have not been identified and diagnosed
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Looking forward to the end, Professor Wang Huali told reporters that AD is a type of chronic disease.
Due to the fast pace and the length of outpatient visits in the tertiary hospitals, the broader stage for the management of AD patients is in the community and the grassroots, requiring multiple disciplines and channels.
Cooperation, so that AD management has a good prospect
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I hope that through this platform, we will promote the standardized diagnosis and treatment of AD and contribute to the management of chronic diseases of AD
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 Expert profile Professor Wang Huali, Peking University Institute of Mental Health (Sixth Hospital), Deputy Director, Beijing Key Laboratory of Translational Medicine for Diagnosis and Treatment of Dementia, Executive Director, World Dementia Council (WDC) Executive Director, International Alzheimer's Disease Association (ADI) Executive Director Executive Director of the Pacific Rim Society of Psychiatry (PRCP) Executive Vice Chairman of the Alzheimer's Disease Branch (ADC) of the Chinese Geriatrics Association Vice President of the Psychiatric and Mental Health Branch of the Chinese Society of Geriatrics Vice President of the Chinese Society of Gerontology and Geriatrics The vice chairman of the professional committee founded the first AD doctor-patient family association in China in 2000, created China's characteristic dementia care and counseling technology, proposed the whole process management concept of cognitive impairment, served as a WHO global dementia monitoring consultant, participated in the preparation of WHO global dementia research key reports, dementia References: [1] Petrovic M, Hurt C, Collins D, et al.
Clustering of behavioural and psychological symptoms in dementia(BPSD): a European Alzheimer's disease consortium(EADC)study.
Acta Clin Belg.
2007;62(6):426-432.
[2]Zhang Meiyan,Wang Huali,Li Tao, et al.
Mental and behavioral symptoms of patients with Alzheimer's disease in the memory clinic of psychiatric department[J].
Chinese Mental Health Journal,2011 ,25(4):259-264.
[3]Geriatric Psychiatry Group of Psychiatric Branch of Chinese Medical Association.
Expert consensus on clinical diagnosis and treatment of neurocognitive disorders and psychobehavioral symptoms[J].
Chinese Journal of Psychiatry,2017,50(5 ): 335-339.