Dementia in the primary care setting.

The first step in assessing behavioral problems in a patient with dementia is to understand why these behaviors occur and what might be causing them. In some instances, new or longstanding problem behaviors may be related to changes occurring within the brain, but in other cases may be related to a physical problem. The second step is to determine if there is a pattern to the patient's behavior. Ask the caregiver to keep a behavioral log for 1 week. Analyze the log for any clues and triggers that may direct you toward making environmental changes. Once you have the behavioral log, the third step is to try and determine specific patterns, environmental factors or triggering events contributing to the behavior. In general, there are three main causes of behavioral problems: environment, tasks and communication. Communication between the caregiver and the patient affected by dementia is one of the most important and most difficult aspects of care. A caregiver support group may be beneficial, as well as a consultation with a social worker. Pharmacologic therapy should only be initiated if the behavioral strategies are clearly not effective after a reasonable period of time, the behavior has been objectively and systematically documented, or the patient is a clear risk to himself or others.