Behavioural symptoms of dementia — RACGP Fellowship MCQ

Correct answer: A — Use environmental and behavioural strategies before considering medication

Non-pharmacological management is the first-line treatment for behavioural and psychological symptoms of dementia (BPSD) per RACGP Silver Book and Australian Prescriber guidance. This patient has agitation clearly triggered by an environmental stressor (house move), with excluded delirium, infection and pain. Environmental modifications, activity programmes, and carer education are evidence-based first steps. Antipsychotics (e.g. risperidone, not haloperidol) are reserved only for those with severe BPSD causing 'significant distress to themselves or others' that fail non-pharmacological approaches, with mandatory review at 4–12 weeks. Haloperidol (option A) is a typical antipsychotic with poor tolerability in elderly patients and is not PBS-listed for BPSD. Benzodiazepines (option B) are not first-line and carry substantial risks (falls, dependence, cognitive decline). Empirical antibiotics without positive cultures (option C) is inappropriate. Physical restraint (option E) is harmful and not standard practice.

Reference: RACGP aged care clinical guide (Silver Book) Part A: Behavioural and psychological symptoms of dementia. 5th edition (2016). https://www.racgp.org.au/getattachment/5e488616-808e-4ac4-99ca-dfeef2c7ce99/Behavioural-and-psychological-symptoms-of-dementia.aspx; Australian Prescriber: Managing behavioural and psychological symptoms in dementia (August 2016). https://australianprescriber.tg.org.au/articles/managing-behavioural-and-psychological-symptoms-in-dementia.html