There is a need for improvement in the current terminology being used to describe behavioral symptoms in dementia/NCD. We have come a long way from labeling someone as “Disruptive,” “Aggressive” or “Agitated,” but there is still work to be done. The issues include:
- Overly encompassing terminology that lacks criteria or context
- Care giver bias during assessment
- Absence of consideration of all factors (biological, social, psychological) affecting the patient
Focusing on the last point, there needs to be stronger consideration of all the factors surrounding a patient living with dementia/NCD. This moves beyond the current models in practice, which focus only on the biological or psychosocial paradigm. We need include all of the following when assessing a patient:
- Biological factors (ex. Stage of the disease)
- Psychological/Personal factors (ex. Acquired coping mechanisms)
- Social/Environmental factors (ex. Milieu structure)
Dementia/NCD is a neuropathological disease which impacts different areas of the brain as it progresses. Subsequently, different behavioral symptoms will emerge that correlate with the stage of the disease and its associated brain pathology. Co-morbidities like depression, anxiety disorder, and Delusional Mis-Identification Syndrome (DMS) will also affect how these symptoms manifest; with mood, anxiety and psychotic symptoms the most influenced.
A person’s personality before their dementia/NCD diagnosis plays a strong role in the type of symptoms they present in the advancing stages of the disease. Pre-morbid personality traits also shape what coping mechanisms patients develop and execute to deal with a variety of social and environmental settings. It is important to know a patient’s traits and coping mechanisms to understand the influence behind the behavioral symptoms they express, and to learn how to address the patient’s needs.
How a person deals with different interpersonal interactions and changes in their milieu structure depends on the stage of their dementia/NCD. As their disease advances, their response to the social and physical environment around them will begin to emerge as behavioral symptoms.
A New Model
To tie these factors all together, there needs to be a comprehensive biopsychosocial (BPS) model. A BPS model looks at the input, processing, and output of a person’s cognitive function, the surrounding biopsychosocial factors, stage of the disease, and the behaviors being expressed. These symptoms are then assessed as Stage Congruent Responsive Behaviors (SCRB) and classified under 12 newly developed behavioral categories: