The BEHAVE-AD Assessment System: A Perspective, A Commentary on New Findings, and A Historical Review

• Published in: Dementia and geriatric cognitive disorders 2014-01, Vol.38 (1-2), p.89-146
• Main Authors: Reisberg, Barry, Monteiro, Isabel, Torossian, Carol, Auer, Stefanie, Shulman, Melanie B., Ghimire, Santosh, Boksay, Istvan, Guillo BenArous, Francoise, Osorio, Ricardo, Vengassery, Aninditha, Imran, Sheema, Shaker, Hussam, Noor, Sadaf, Naqvi, Shazia, Kenowsky, Sunnie, Xu, Jinfeng
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Alzheimer Disease - diagnosis; Alzheimer Disease - psychology; Alzheimer Disease - therapy; Behavioral Symptoms - diagnosis; Behavioral Symptoms - therapy; Biological and medical sciences; Cost of Illness; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia - diagnosis; Dementia - psychology; Dementia - therapy; Disease Management; General aspects; Humans; Medical sciences; Neurology; Neuropharmacology; Neuroprotective agent; Neuropsychological Tests; Organic mental disorders. Neuropsychology; Patient Outcome Assessment; Pharmacology. Drug treatments; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotropic Drugs - therapeutic use; Review Article; Symptom Assessment - methods
• ISSN: 1420-8008; 1421-9824
• DOI: 10.1159/000357839

Background: Behavioral and psychological symptoms of dementia (BPSD) and associated disturbances in Alzheimer's disease (AD) are a source of distress and burden for spouses, professional caregivers, and others with responsibilities for the care of individuals with AD. BPSD with behavioral disturbances are also associated with more rapid institutionalization and increased morbidity and mortality for persons with AD. Objectives: In this review and commentary, we discuss the history of the development of BPSD and behavioral disturbance assessments, which are distinct from those evaluating cognitive and functional symptoms of AD. In particular, we review the informant-based Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), the related, potentially more sensitive, BEHAVE-AD Frequency-Weighted Severity Scale (BEHAVE-AD-FW), and the direct subject evaluation-based Empirical BEHAVE-AD Rating Scale (E-BEHAVE-AD). The kinds of medications that alleviate behavioral symptoms on these measures as well as the problems and possibilities for further advances with these medications are discussed. Finally, the importance of distinguishing BPSD and behavioral disturbance remediation in AD from the treatment of cognitive decline and other aspects of AD is emphasized in the context of appropriate assessment methodology. The objective of this paper is to provide a framework for further advances in the treatment of BPSD and associated behavioral disturbances in AD and, consequently, a framework for continuing improvements in the lives of individuals with AD and those who share the burden of the disease with the AD person.