neurologic disorders
Behavioral and Psychologic Symptoms of Dementia
Evaluation
Characterization of behaviors (eg, by Cohen-Mansfield Agitation Inventory) Recording of specific behaviors Evaluation for coexisting depression and psychosis The best approach is to characterize and classify the behavior, rather than to label all such behaviors agitation, a term with too many meanings to be useful. TheCohen-Mansfield Agitation Inventoryis commonly used; it classifies behaviors as follows: Physically aggressive:For example, hitting, pushing, kicking, biting, scratching, or grabbing people or things Physically nonaggressive:For example, handling things inappropriately, hiding things, dressing or undressing inappropriately, pacing, repeating mannerisms or sentences, acting restless, or trying to go elsewhere Verbally aggressive:For example, cursing, making strange noises, screaming, or having temper outbursts Verbally nonaggressive:For example, complaining, whining, constantly requesting attention, not liking anything, interrupting with relevant or irrelevant remarks, or being negative or bossy The following information should be recorded: Specific behaviors Precipitating events (eg, feeding, toileting, medication administration, visits) Time the behavior started and resolved This information helps identify changes in pattern or intensity of a behavior and makes planning a management strategy easier. If behavior changes, a physical examination should be done to exclude physical disorders and physical abuse, but environmental changes (eg, a different caregiver) should also be noted because they, rather than a patient-related factor, may be the reason. Depressive Disorders , Symptom categories in schizophrenia None Delusions without paranoia may be confused with disorientation, but delusions are usually fixed (eg, a nursing home is repeatedly called a prison), and disorientation varies (eg, a nursing home is called a prison, a restaurant, and a home). Hallucinations occur without external sensory stimuli; hallucinations should be distinguished from illusions, which involve misinterpreting external sensory stimuli (eg, cellular phones, pagers). 