Management of behavioural and psychological symptoms of dementia: a pragmatic scoping review of European guidelines and literature

Purpose: Dementia prevalence within the European Union (EU) is expected to double by 2050. Behavioural and Psychological Symptoms of Dementia (BPSD) are common, causing burden to patients and caregivers. This pragmatic scoping review aims to synthesize recommendations of European BPSD management guidelines and literature, highlighting areas of consensus and disagreement.

Methods: An electronic literature search including Medline, PsychINFO and CINAHL and internet search for grey literature were undertaken to identify published BPSD guidelines from the EU, European Economic Area (EEA) and UK, supplemented by contacting EU member countries of European Geriatric Medicine Society (EuGMS).

Results: The literature search found 11 papers describing BPSD management. Of the 32 countries of interest, 22 guidelines were sourced (five no guidelines, five no response). There was a general consensus between the guidelines, as all recommended comprehensive assessment and individualised approaches, with non-pharmacological therapies as first line, but there was disagreement around specific therapies. Psychoeducation was most commonly recommended (15 countries). There was a general agreement that pharmacological treatment should be used as an adjunct to non-pharmacological interventions, but recommendations differed between medication
groups. Short term atypical antipsychotics were most commonly recommended,especially
risperidone (18 countries). 15 countries recommended acetylcholinesterase inhibitors and 12 memantine. 16 countries recommended the use of SSRIs. Recommendations for the use of sedative medications and anti-epileptics varied.

Conclusions: This study provides a broad, inclusive overview of current European guidelines for the management of BPSD, demonstrating significant variability. Clinical practice in dementia care throughout Europe needs to be optimized and standardized.