Assessment of Behavioral and Psychological Symptoms of Distress (BPSD)

One of the first steps in responding to the Behavioral and Psychological Symptoms of Distress (BPSD) through pharmacological treatments or non-pharmacological approaches is to detect their occurrence.[1] There is a growing consensus that early and ongoing assessment of behaviors can lead to a more effective response. For example, the AMA Performance Dementia Measurement Set recommends that health providers systematically screen for behaviors at a minimum once a year using a standardized assessment tool. It is unclear, however, which assessment tool to use and whether sufficient standardized approaches to ongoing behavioral detection are available from which effective plans for response can be derived. Nevertheless, behavior should be assessed on a frequent, ongoing, and systematic basis so that patterns can be identified that will help inform the design of NPA.

To evaluate the state-of-science concerning behavioral assessments, a comprehensive review of available published measures was conducted and their psychometric properties summarized. A final set of 44 measures were identified, with most having adequate psychometric properties. The majority of measures (n=15) covered a broad range of behaviors and were developed for use in dementia care or in nursing homes. Measures were also found for specific neuropsychiatric symptoms, including agitation, apathy, aggression, depression, anxiety, sleep, and wandering, though these were less likely to be specific for a dementia population. No specific measures were identified separate from the general measures, which addressed behaviors such as euphoria, hallucinations, irritability apart from aggression or anxiety, and/or motor and verbal disturbances. Table 1 lists all 44 measures and their essential properties. Table 2 summarizes the number of measures for each behavioral category considered. Table 3 compares the 44 measures in terms of settings, number of items, and behavioral categories included.

[1]Note: For any resident who exhibits an acute and fluctuating change in behavior, an initial assessment for delirium should be made to rule out the presence of acute medical conditions. Two recent systematic reviews of instruments to detect delirium may be useful to staff trained in their administration:

  1. Morandi, A., McCurley, J., Vasilevskis, E., et al. (2012). Tools to detect delirium superimposed on dementia: A systematic review. Journal of the American Geriatrics Society. 2012;60:2005–2012.
  2. Wong, C., Holroyd-Leduc, J., Simel, D., et al. Does this patient have delirium? Value of bedside instruments. Journal of the American Medical Association. 2010;304:779-786.