The Canadian Coalition for Seniors’ Mental Health (CCSMH) has released a new Canadian Clinical Practice Guidelines for Assessing and Managing Behavioral and Psychological Symptoms of Dementia (BPSD) at the end of March 2024.
A summary of the CCSMH LTC Recommendations for Assessing and Managing BPSD 2024 is sorted by topic and then by the strength of the recommendation and evidence quality based on the GRADE assessment.
The CPG includes 10 Good Practice Statements and 63 recommendations in five major areas of BPSD:
- Agitation
- Psychosis (including delusions and hallucinations)
- Depressive symptoms and depression
- Anxiety
- Sexual expressions of potential risk
The geriatric psychiatrist and geriatrician co-chairs of the guideline panel hosted a webinar in March to review the BPSD clinical practice guideline:
Significant medication-related recommendations:
- Risperidone followed by aripiprazole is recommended as first-line medications for severe agitation and severe psychosis
- Citalopram is recommended for moderate agitation, moderate psychosis, and moderate-severe anxiety
- Quetiapine is suggested second-line for severe agitation if symptoms are refractory to other pharmacological treatments, or in cases where other treatments are not tolerated due to extrapyramidal side-effects
- Olanzapine is recommended against for agitation
- Several medications are suggested against for agitation: trazodone, sertraline, mirtazapine, fluoxetine, paroxetine, fluvoxamine, tricyclic antidepressants, valproic acid or sodium divalproex
- Long-acting antipsychotics are recommended against for BPSD in the absence of a co-occurring chronic psychotic illness pre-dating the diagnosis of dementia
- Using multiple medications (polypharmacy) is recommended against for agitation
- Deprescribing antipsychotics is recommended for those who do not have a history of serious mental illness requiring antipsychotics and whose agitation and psychosis symptoms have stabilized
CCSMH has also recently updated the following guidelines:
In addition to the release of the BPSD clinical practice guideline, CCSMH has also launched a new website on: Behaviors in Dementia which has a collection of resources on many topics related to behaviors in dementia for patients, caregivers, and health care providers.