Disruptive, Aggressive, Agitated. We have advanced far from the terminology once used to describe the behavioral symptoms in dementia/NCD. Today, you will hear terms such as “Responsive Behaviors” and “BPSD” used by healthcare professionals to describe the behavioral symptoms seen in this patient population. It is important to know the background of the used terminology, so that we can see what areas still need improvement.
“Disruptive Behavior” is a broadly used label for the “problem” behaviors care givers experience when working with patients with dementia/NCD. This term is both confusing and inconsiderate, as it covers a wide range of unrelated symptoms and focuses more on the care giver’s perspective rather than the patient’s experience.
The term “Aggressive” is used to describe any physical, verbal or sexual action aimed at another organism, object, or oneself. When used in assessment, there is usually little clarification on the type of “aggressive” behavior being expressed and whether the behavior is recurrent or not. Care giver bias also plays a role when assessing patient as “aggressive” or not, further reducing the reliability of this terminology.
“Agitation” describes inappropriate activity that cannot be justified by needs or confusion. It has specific criteria and is measured by the Cohen-Mansfield Agitation Inventory Scale (CMAI). It can only be used as a label once the healthcare professional rules out a wide range of co-morbidities.
Behavioral and Psychological Symptoms of Dementia/NCD (BPSD)
The label “Behavioral and Psychological Symptoms of Dementia/NCD (BPSD)” has been established as the wide-ranging term to use when assessing non-cognitive symptoms in dementia. It encompasses all the behaviors listed above and much more, but contains limitations as well. Assessing BPSD in patients with moderate to advanced dementia/NCD tends to be the most challenging, as all mood, anxiety, and psychotic co-morbidities and delirium need to be ruled out prior to diagnosing BPSD. As well, there is an inherent disconnect between the paradigm used to label behaviors under BPSD and the one used to quantify behaviors.
Room for Improvement
Healthcare is beginning to move in the right direction, starting with new terminology like “Responsive Behavior” (RB). RB is a recently proposed label that views the behavior through the patient’s perspective rather than the care giver’s burden. What is now being proposed is a more comprehensive terminology called Stage Congruent Responsive Behaviors (SCRB), pronounced “scrub,” which considers the stage of the disease and all biopsychosocial factors influencing the behavior. A new assessment scale titled LuBAIR has also been developed to address the disconnect between the definitions currently used to label behaviors and the tools typically used the quantify and measure these behaviors. Following a comprehensive list of 12 newly developed behavioral categories, LuBAIR Scale assesses behaviors in D/NCD in a more clinically meaningful way.