A 70-year-old man with Alzheimer's disease has behavioural and psychological symptoms of dementia (BPSD) — agitation, aggression, and sleep disturbance — causing significant caregiver distress. First-line management should be:
- A Non-pharmacological interventions (structured activities, sensory modulation, caregiver education) ✓
- B Haloperidol 2 mg at night
- C Diazepam 5 mg as needed
- D Rivastigmine dose increase
Explanation
For BPSD in Alzheimer's disease, international consensus guidelines (NICE, BAP) recommend non-pharmacological approaches as first-line: structured daily routines, meaningful activities, person-centred care, sensory modulation, caregiver education and support, and environmental modifications. Pharmacological treatment (low-dose atypical antipsychotics) is reserved for moderate-severe agitation or psychosis with risk of harm to self or others, and only after failed non-pharmacological measures, due to significant adverse effects including increased stroke risk and mortality in elderly with dementia (FDA/NICE black box warning). Benzodiazepines worsen confusion and increase fall risk.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.