In this episode, I talk with Dr. George Grossberg, a pioneer in geriatric psychiatry, about the neuropsychiatric symptoms of dementia and what they look like, why they happen, and how to approach them with empathy and strategy. We walk through the most common behavioral disturbances in dementia, including apathy, depression, psychosis, and agitation. Dr. Grossberg shares how to think through these cases, when to reach for medication, when to hold back, and how to anchor every decision in an understanding of who the patient truly is.

Takeaways:

Neuropsychiatric symptoms are nearly universal in dementia. Expect them, don’t be surprised by them.
Apathy and depression aren’t the same. Treating apathy like depression often fails; gentle engagement works better than antidepressants.
Start with environment and empathy. Music, structure, exercise, and caregiver education should come before medication.
Use medication sparingly and strategically. When needed, match the drug to the symptom, and always reassess risk versus relief.
Knowing the person changes everything. Understanding a patient’s history, preferences, and rhythms is as therapeutic as any pharmacologic plan.

Selected References:

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