Outdoor activity, massage, and touch therapy ranked most effective for agitation in dementia. Risperidone doesn’t appear to cause fractures.

Screening tests can also help distinguish normal aging from a Neurocognitive Disorder. The popular Mini Mental Status Exam is being replaced by more sensitive tests like the Montreal Cognitive Assessment (MOCA) and the Saint Louis University Mental Status Examination (SLUMS). Both of these can be completed in 10 minutes and are normed for Mild and Major Neurocognitive Disorders. An abbreviated form of the SLUMS, the Rapid Cognitive Screen, can be administered in 5 minutes.

Excessive alcohol use is neurotoxic, but some studies have found that moderate alcohol intake might actually reduce the risk of dementia. Most of these studies, however, have focused on geriatric patients.

The most common cause of parkinsonism is Parkinson disease, but parkinsonism also can occur from the use of any medication that blocks the D2 (dopamine type 2) receptor. Those include antipsychotics but can also include non-psychiatric medicines, particularly metoclopramide (Reglan), an anti-nausea medicine.

As director of psychiatry at Hebrew SeniorLife for 18 years, Dr. Metzger has witnessed a number of changes in how we manage agitation and other elements of BPSD. In this article, he outlines current thinking about such symptoms, as well as the latest techniques—both pharmacologic and non-pharmacologic—for managing them.

There used to be this rule of thumb that you don’t need to worry about people who are worried about their memory; you need to worry about people who aren’t worried. And that might be true for people with dementia, where there is often a loss of insight. But if you want to pick up memory problems at the earlier, mild cognitive impairment stage, do an evaluation when someone is worried about memory loss.

It’s possible that BZD use causes cognitive decline, but it’s equally possible that patients with preexisting dementia are prescribed BZDs to alleviate psychiatric symptoms related to dementia. A new, very large study adds to our fund of knowledge on this issue.