“Slight changes from before” could be a sign of BPSD (Behavioral and Psychological Symptoms of Dementia) — Visualizing family caregivers’ observations to enable appropriate medical care and peace of mind for patients

Otsuka Pharmaceutical, as a total healthcare company committed to unlocking each individual’s potential, is working toward realizing well-being—where people are physically, mentally, and socially healthy. In Alzheimer’s disease, symptoms go beyond memory loss and cognitive decline, often including behavioral and emotional changes such as becoming easily angered, restlessness, or resisting care and support. These are known as BPSD (Behavioral and Psychological Symptoms of Dementia), which may stem from the individual’s anxiety, confusion, or environmental factors. However, such changes are often dismissed as “just aging” or “personality changes” and overlooked. Even when family members or caregivers notice these changes, they may be unsure how to communicate them during medical consultations. One effective tool to organize these daily observations and connect them to appropriate care is the 'Assessment Sheet for Behavioral Symptoms Associated with Dementia'.

This time, we spoke with Dr. Hikaru Furuta, Head of Psychiatry and Director of the Dementia Medical Care Center at the Tokyo Metropolitan Geriatric Hospital & Institute of Gerontology, about dementia care principles, challenges in recognizing BPSD, and the role of the assessment sheet.

## The goal of dementia care: continuing a life that reflects the individual

— What is most important in dementia care?

[Dr. Furuta]

The most important aspect of dementia treatment and care is enabling the person and their family to continue living a life that reflects who they truly are, for as long as possible. In clinical settings, we prioritize carefully listening to both the individual and their family, including their concerns.

When people think of dementia, they often picture cognitive impairments like forgetfulness. However, dementia symptoms can be broadly categorized into two types: 'cognitive impairments' such as memory loss and reduced judgment, and 'BPSD (Behavioral and Psychological Symptoms of Dementia)'—behavioral and psychological symptoms. BPSD encompasses a wide range of symptoms, varying in expression and severity among individuals, but many can improve with appropriate interventions and care.

### [Examples of BPSD symptoms]

- Agitation and behavioral changes: suddenly shouting, attempting to hit, restlessly pacing
- Depression and anxiety: feeling down, experiencing intense anxiety
- Distorted perception of reality: seeing people or objects that aren’t there, believing one’s wallet has been stolen
- Loss of motivation: losing interest in previously enjoyed activities, appearing apathetic or indifferent

These BPSD symptoms can be difficult to objectively assess. To family members and caregivers, they may seem challenging to manage. However, they often reflect the person’s underlying anxiety or confusion. Making daily behaviors and difficulties visible, and examining the context behind these behaviors—'why is this happening?'—is the first step toward supporting a life that reflects the individual and their family.

## Irritability, restlessness… 'Slight changes from before' could be a sign of BPSD

— Many people may not realize that changes like 'becoming more irritable' could be symptoms of dementia, correct?

[Dr. Furuta]

It’s not uncommon for people to be surprised when we explain that symptoms like 'increased irritability' or 'loss of interest in daily activities' are associated with dementia. Some family members say, 'That’s just their personality.' BPSD is often mistaken for aging or personality changes, or even seen as 'not something to discuss with a doctor.' Some individuals, despite struggling, may hesitate or avoid consulting a physician. In general outpatient settings, consultations often focus on memory issues or medication, and people with dementia may find it difficult to express what’s troubling them. There’s often insufficient time or opportunity to discuss subtle changes occurring in daily life. However, emotional distress or behavioral changes that differ from the person’s usual self could be signs of BPSD.

## Visualizing BPSD through daily changes and observations: the assessment sheet

— How should families and caregivers communicate their sense of 'something being slightly different' to healthcare providers during consultations?

[Dr. Furuta]

A useful tool for conveying these subtle daily changes and observations to doctors, nurses, or other healthcare and caregiving professionals is the 'Assessment Sheet for Behavioral Symptoms Associated with Dementia.' This tool helps 'visualize' BPSD, enabling objective understanding and facilitating more appropriate treatment and support. It allows users to assess 13 common behavioral symptoms—those most noticeable in daily life—on a five-point scale.

Additionally, we’ve prioritized clarity by including illustrations, so even symptoms that are hard to grasp through words alone can trigger intuitive recognition—'Ah, this is exactly what’s happening.'

Using this sheet can spark conversations with healthcare and caregiving professionals about which symptoms are causing difficulties and how to manage them. By expanding the discussion with questions like 'Can you describe specific incidents?', it becomes easier to accurately understand the individual’s condition and daily changes, aiding diagnosis and treatment planning.

The assessment sheet can be downloaded from the following page:

Download URL: https://www.smilenavigator.jp/ninchisyo/information/download/

## More important than scores: tracking changes over time

— How should the assessment sheet be used to support treatment and care?

[Dr. Furuta]

The sheet isn’t meant to be filled out just once. It’s designed to record up to three assessments, enabling regular monitoring and documentation to track changes in the individual’s condition over time. This allows caregivers and clinicians to observe the effects of medication or care strategies as longitudinal changes. We also recommend using the blank spaces to note any additional observations.

There’s no need to think, 'Since none of the listed symptoms apply, there’s nothing to discuss.' Even observations outside the listed items can provide valuable clues for diagnosis and care planning, whether or not they’re clearly linked to dementia. Please share any insights you have.

Filling out the sheet can deepen family members’ and caregivers’ understanding of dementia symptoms. Seeing changes documented may also help families feel more empowered and proactive. For those already using day services or care facilities, sharing the sheet with staff or having them record observations can be beneficial.

When interpreting the sheet, it’s also important not to overemphasize the scores. Don’t treat the checked numbers as absolute scores. Instead, use them as a starting point to understand the current situation and initiate detailed conversations. A high score doesn’t necessarily mean 'bad,' nor does a low score mean 'no problems.' What matters most is exploring the background of daily behaviors and changes, and using that insight to inform care and treatment.

## From 'I don’t know what to talk about' to taking the first step toward shared support with professionals

— What message would you most like to convey to people living with dementia and their families?

[Dr. Furuta]

I often hear, 'I don’t know what to bring up' or 'there’s not enough time to talk.' The assessment sheet is a tool designed to help families and caregivers organize their observations and share them with healthcare providers. By filling it out before a consultation, you can clarify what you want to communicate and use limited appointment time more efficiently. Sharing records among multiple caregivers may also reveal differing perspectives, leading to more comprehensive care. Please don’t carry the burden alone—use this sheet to collaborate with professionals in supporting the individual’s peace of mind and a life that reflects who they are.