Dementia with psychotic behavior disorder (BPSD) is one of the symptoms of dementia. It includes a range of symptoms such as hallucinations, delusions, paranoia, suspicion, screaming for no reason, aimless wandering, emotional anxiety or depression, inability to quiet down, apathy, temper tantrums, impulsivity and hurtfulness, and disorderly behavior. Patients can have multiple psychobehavioral symptoms at the same time, or they can exhibit only one. The dementia referred to here also includes multiple types of dementia, such as Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia.
Almost all symptoms of mental disorders can be found in the clinical manifestations of dementia, but these mental behavioral disorders are different from what is commonly referred to as “mental illness”, and their symptoms have their own characteristics. Moreover, as the disease progresses, the clinical manifestations are completely different in mild, moderate and severe stages.
The main clinical manifestations are as follows.
1.Anxiety/Depression
Patients show depressed mood, easily nervous, sensitive, sometimes paranoid, fidgety, repeatedly go to the bathroom to urinate and defecate, have a lot of worries about their bad memory, and even have negative thoughts or behaviors. These symptoms usually appear early in the disease and are even more pronounced than the symptoms of memory impairment. Therefore, they are sometimes misdiagnosed as depression in old age.
2. Paranoia/Suspicion
Appearing when the disease is mild to moderate, patients show paranoia, vigilance, difficulty getting along, and always think that others have done something against them. Many patients are suspicious that others have stolen their money and are hostile to people who come to take care of them. Patients often cannot find things due to poor memory and always think that others have taken them away, for this reason they put things in more hidden places, but soon they do not remember and cannot find them even more. Therefore suspicion is high. A small number of patients will stubbornly believe that someone is trying to harm him, or that his spouse is unfaithful to him, or insist on identifying something that has not happened and is difficult to convince with strong words.
3. Temper tantrums/damage to others
The patient’s temperament becomes different or worse than before, easily provoked, unapproachable, cursing, destroying things or even hurting people when impulsive.
4.Excitement/fear
Performance behavior or speech increased, or easy to fear screaming. A small number of patients show sexual arousal, frivolous and indiscreet speech and behavior.
5.Repetitive speech/repetitive action
Due to poor memory, patients will repeatedly ask questions or say one thing. Some patients have repetitive nonsensical behaviors, such as repeatedly rolling up the corners of their clothes, repeatedly opening and closing drawers, and fumbling with something.
6. Day and night reversal/nocturnal roaming
Patients have disturbed sleep rhythms, sleep during the day and get up at night, roam around the room, repeatedly go to the toilet or do something meaningless. Sometimes, the patient knocks around, walks to the children’s room, or even wanders outside aimlessly.
7.Hallucinations/delusions
Patients may see something in the room that does not exist, or they may claim to see a villain or a devil and ask others to look at them, sometimes realizing that they are hallucinations after being denied by others. Delusions are when the patient insists on believing something that does not exist, such as believing that a neighbor is intent on harming him or that his spouse is having an affair with someone else. However, it is important to note that sometimes it is the patient’s memory that is wrong, such as claiming that a family member or friend just came over, or seeing the spouse in bed with the opposite sex. It is not necessarily that the patient is hallucinating or fantasizing, but rather that the patient has a memory disorder and treats the contents of past memories or dreams as if they have just happened.
8. Dependency/infantilism
Patients are especially dependent on a caregiver, sometimes not allowing that caregiver to leave for a moment, panicking or even making noise when they are not seen for a few minutes, and refusing other caregivers. Some patients may behave childishly or like to approach children, and are happy to interact with children they know or do not know.
9. Indifference
Patients lose interest in things that used to interest or concern them, and lose the ability to be concerned or worried about their loved ones. For example, indifference to children’s affairs, family changes, visits from children and grandchildren, and past hobbies. Apathy differs from depression in that apathy refers to the absence and hollowness of emotions, while depression refers to the presence of emotions, but the lack of interest in certain things due to depression and low mood.