Review Article| Volume 39, ISSUE 1, P161-175, February 2023

Download started.


Diagnostic and Management Strategies for Common Neurobehavioral and Psychiatric Disturbances Among Patients with Cognitive Impairment and the Dementias

Published:October 18, 2022DOI:


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Geriatric Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Borsje P.
        • Wetzels R.B.
        • Lucassen P.L.
        • et al.
        The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review.
        Int Psychogeriatr. 2015; 27: 385-405
        • Fauth E.B.
        • Gibbons A.
        Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms.
        Int J Geriatr Psychiatry. 2014; 29: 263-271
        • Cummings J.L.
        • Mega M.
        • Gray K.
        • et al.
        The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia.
        Neurology. 1994; 44: 2308-2314
        • Inouye S.K.
        • Westendorp R.G.
        • Saczynski J.S.
        Delirium in elderly people.
        Lancet. 2014; 383: 911-922
        • De J.
        • Wand A.P.
        Delirium screening: a systematic review of delirium screening tools in hospitalized patients.
        Gerontologist. 2015; 55: 1079-1099
        • Watt J.A.
        • Thompson W.
        • Marple R.
        • et al.
        Managing neuropsychiatric symptoms in patients with dementia.
        BMJ. 2022; 376: e069187
        • Watt J.A.
        • Goodarzi Z.
        • Veroniki A.A.
        • et al.
        Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis.
        BMJ. 2021; 372: n532
        • Watt J.A.
        • Goodarzi Z.
        • Veroniki A.A.
        • et al.
        Comparative efficacy of interventions for aggressive and agitated behaviors in dementia: a systematic review and network meta-analysis.
        Ann Intern Med. 2019; 171: 633-642
        • Press D.
        • Alexander M.
        Management of neuropsychiatric symptoms of dementia.
        UpToDate, Waltham, MA Accessed. 2014; 3: 20
        • Dennis M.
        • Shine L.
        • John A.
        • et al.
        Risk of adverse outcomes for older people with dementia prescribed antipsychotic medication: a population based e-cohort study.
        Neurol Ther. 2017; 6: 57-77
        • Gill S.
        • Rochon P.
        • Herrmann N.
        • et al.
        Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study.
        BMJ. 2005; 330
        • Schneider Lon S.
        • Dagerman Karen S.
        Insel Philip: risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials.
        JAMA. 2005; 294: 1934-1943
        • Sterke C.S.
        • van Beeck E.F.
        • van der Velde N.
        • et al.
        New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia.
        J Clin Pharmacol. 2012; 52: 947-955
        • Gerlach L.B.
        • Kales H.C.
        • Kim H.M.
        • et al.
        Trends in antipsychotic and mood stabilizer prescribing in long-term care in the US: 2011–2014.
        J the Am Medical Directors Assoc. 2020; 21: 1629-1635.e8
        • Vasudev A.
        • Shariff S.Z.
        • Liu K.
        • et al.
        Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004–2013.
        Am J Geriatr Psychiatry. 2015; 23: 1259-1269
        • Donegan K.
        • Fox N.
        • Black N.
        • et al.
        Trends in diagnosis and treatment for people with dementia in the UK from 2005 to 2015: a longitudinal retrospective cohort study.
        Lancet Public Health. 2017; 2: e149-e156
        • Association AP
        What are anxiety disorders?.
        (Accessed 7 January 2022)
        • Maria Cecilia Freitas-Ferrari J.E.C.H.
        • Trzesniak Clarissa
        • Alaor Santos Filho
        • et al.
        Neuroimaging in social anxiety disorder: a systematic review of the literature.
        Prog Neuro-Psychopharmacology Biol Psychiatry. 2010; 34: 565-580
        • Chand S.P.
        • Marwaha R.
        StatPearls Publishing, Treasure Island (FL)2022 (Available at:)
        • Michelle G.
        • Craske M.B.S.
        Lancet. 2016; 388: 3048-3059
        • American Psychiatric Association
        Anxiety disorders : DSM-5 selections. xiv. American Psychiatric Association Publishing, Arlington, VA2016: 114
        • Cortés N.
        • Andrade V.
        • Maccioni R.B.
        Behavioral and neuropsychiatric disorders in Alzheimer's disease.
        J Alzheimer's Dis. 2018; 63: 899-910
        • Goodarzi Z.
        • Samii L.
        • Azeem F.
        • et al.
        Detection of anxiety symptoms in persons with dementia: a systematic review.
        Alzheimers Dement (Amst). 2019; 11: 340-347
        • Orgeta V.
        • Leung P.
        • Del-Pino-Casado R.
        • et al.
        Psychological treatments for depression and anxiety in dementia and mild cognitive impairment.
        Cochrane Database Syst Rev. 2022; 4 (PubMed PMID: 35466396; PMCID: PMC9035877 not involved in data extraction for this study. AS and MO were principal investigators in one of the included studies, and were not involved in data extraction for this study. There are no other known conflicts of interest): Cd009125
        • Mann R.S.
        Differential diagnosis and classification of apathy.
        Am J Psychiatry. 1990; 147: 22-30
        • Chase T.N.
        Apathy in neuropsychiatric disease: diagnosis, pathophysiology, and treatment.
        Neurotoxicity Res. 2011; 19: 266-278
        • Chong T.-J.
        • Husain M.
        The role of dopamine in the pathophysiology and treatment of apathy.
        Prog Brain Res. 2016; 229: 389-426
        • David R.
        • Koulibaly M.
        • Benoit M.
        • et al.
        Striatal dopamine transporter levels correlate with apathy in neurodegenerative diseases: a SPECT study with partial volume effect correction.
        Clin Neurol Neurosurg. 2008; 110: 19-24
        • Hum S.
        • Fellows L.K.
        • Lourenco C.
        • et al.
        Are the items of the starkstein apathy scale fit for the purpose of measuring apathy post-stroke?.
        Front Psychol. 2021; 12
        • Oba H.
        • Kobayashi R.
        • Kawakatsu S.
        • et al.
        Non-pharmacological approaches to apathy and depression: a scoping review of mild cognitive impairment and dementia.
        Front Psychol. 2022; 13: 815913
        • Wang S.
        • Nussbaum A.M.
        • American Psychiatric Association
        First edition. DSM-5 pocket guide for elder mental health. ix. American Psychiatric Association Publishing, Arlington, Virginia2017: 364
        • Sullivan P.F.
        • Neale M.C.
        • Kendler K.S.
        Genetic epidemiology of major depression: review and meta-analysis.
        Am J Psychiatry. 2000; 157: 1552-1562
        • Hasler G.
        Pathophysiology of depression: do we have any solid evidence of interest to clinicians?.
        World Psychiatry. 2010; 9: 155
        • Lotrich F.E.
        • El-Gabalawy H.
        • Guenther L.C.
        • et al.
        The role of inflammation in the pathophysiology of depression: different treatments and their effects.
        J Rheumatol Suppl. 2011; 88: 48-54
        • Aizenstein H.J.
        • Baskys A.
        • Boldrini M.
        • et al.
        Vascular depression consensus report - a critical update.
        BMC Med. 2016; 14: 161
        • Geerlings M.I.
        • den Heijer T.
        • Koudstaal P.J.
        • et al.
        History of depression, depressive symptoms, and medial temporal lobe atrophy and the risk of Alzheimer disease.
        Neurology. 2008; 70: 1258-1264
        • Nemeroff C.B.
        The state of our understanding of the pathophysiology and optimal treatment of depression: glass half full or half empty?.
        Am J Psychiatry. 2020; 177: 671-685
        • Jones B.N.
        • Reifler B.V.
        Depression coexisting with dementia. Evaluation and treatment.
        Med Clin North Am. 1994; 78: 823-840
        • Pocklington C.
        • Gilbody S.
        • Manea L.
        • et al.
        The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis.
        Int J Geriatr Psychiatry. 2016; 31: 837-857
        • McGivney S.A.
        • Mulvihill M.
        • Taylor B.
        Validating the GDS depression screen in the nursing home.
        J the Am Geriatr Soc. 1994; 42: 490-492
        • Logsdon R.G.
        • Teri L.
        Depression in Alzheimer's disease patients: caregivers as surrogate reporters.
        J Am Geriatr Soc. 1995; 43: 150-155
        • Alexopoulos G.S.
        • Abrams R.C.
        • Young R.C.
        • et al.
        Cornell scale for depression in dementia.
        Biol Psychiatry. 1988; 23: 271-284
        • Lyketsos C.G.
        • Lee H.B.
        Diagnosis and treatment of depression in Alzheimer’s disease.
        Dement Geriatr Cogn Disord. 2004; 17: 55-64
        • Weissman M.
        • Verdeli H.
        Interpersonal psychotherapy: evaluation, support, triage.
        Clin Psychol Psychother. 2012; 19: 106-112
        • Espinoza R.T.
        • Unützer J.
        • Schmader K.E.
        Diagnosis and management of late-life unipolar depression.
        2. UpToDate, Waltham (MA)2015 (Wolters Kluwer Accessed on August)
        • Areán P.A.
        • Raue P.
        • Mackin R.S.
        • et al.
        Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction.
        Am J Psychiatry. 2010; 167: 1391-1398
        • Lyketsos C.G.
        • DelCampo L.
        • Steinberg M.
        • et al.
        Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS.
        Arch Gen Psychiatry. 2003; 60: 737-746
      1. Netzel P.J. The physician’s guide to depression and bipolar disorders. Mayo Clinic Proceedings. Elsevier, Rochester, MN2007
        • Manschreck T.
        Delusional disorder. The spectrum of psychotic disorders Neurobiol Etiol Pathogenesis.
        Cambridge University Press, Cambridge2007: 116-136
        • Waters F.
        • Fernyhough C.
        Hallucinations: a systematic review of points of similarity and difference across diagnostic classes.
        Schizophr Bull. 2017; 43: 32-43
        • Arciniegas D.B.
        Continuum (Minneapolis, Minn). 2015; 21: 715-736
        • Manschreck T.C.
        Pathogenesis of delusions.
        Psychiatr Clin North America. 1995; 18: 213-229