自2022年5月起搭配國衛院研究計畫於北、中、南各地進行多場『照護失智症合併精神行為問題症狀(PCBPSD)訓練課程』，我們接觸到許多因為失智症者行為問題症狀造成照顧困難的家庭照顧者，也從家屬與照顧服務人員的口中進一步認識失智症者在居家可能表現出各式各樣的行為問題。於是開始思考是否可從失智症者的個性、生活習慣、居住環境及問題發生的當下了解個案想要傳達什麼樣的訊息等角度，找出可能解決行為問題的方法與態度。兩年多來我們蒐集到許多行為問題症狀，透過家屬及專業講師課堂分享與經驗交流，目前彙整出二十五個常見的行為問題個案，以深入淺出的文字與生動有趣的插圖向讀者傳遞認識失智症合併精神行為問題與可能的因應方式。

Dr. Chia-Ming Yen is Assistant Investigator at the National Center for Geriatrics and Welfare Research, National Health Research Institutes (NHRI), Taiwan, R.O.C.. Her areas of expertise include dementia care, non-pharmacological interventions, social aspects of aging, adult education, and qualitative research. Since 2022, Dr. Yen has led a research project at NHRI entitled Intervention Strategies and Effectiveness for Managing Behavioral and Psychological Symptoms of Dementia (BPSD). As part of this initiative, she has promoted the Program for Coping with Behavioral and Psychological Symptoms of Dementia (PCBPSD) aimed at enhancing the knowledge and skills of family caregivers, long-term care and healthcare professionals in dementia care.
In 2024, she published a practical handbook titled Dementia Without Losing Spirit: Common Behavioral and Psychological Symptoms and Coping Strategies, featuring 25 common BPSD case scenarios along with suggested intervention strategies. The handbook is designed for a broad audience, including persons with dementia and their families, long-term care and healthcare professionals, and members of the general public interested in dementia care. To support multicultural care communication, the handbook is also available in Indonesian and English versions.
Dr. Yen has published multiple research articles on dementia care in reputable domestic and international academic journals and has presented her work at internationally recognized conferences. She is committed to fostering interdisciplinary collaboration to advance both the practice and scholarship of dementia care.

Since May 2022, in collaboration with the National Health Research Institutes (NHRI), we have conducted a series of training sessions on Program for Coping with Behavioral and Psychological Symptoms of Dementia (PCBPSD) across northern, central, and southern Taiwan. Through these courses, we met numerous family caregivers facing immense challenges due to behavioral symptoms exhibited by their loved ones with dementia. From the experiences and accounts shared by both family members, long-term care and healthcare professionals, we gained a deeper understanding of the wide range of behavioral issues that can emerge in home settings.

These encounters led us to consider whether behavioral symptoms might be better interpreted by exploring the individual’s personality, lifestyle habits, living environment, and the specific circumstances under which these symptoms occur—perhaps as attempts by the person with dementia to communicate unspoken needs or feelings. Over the past two years, we have collected many such behavioral cases. Drawing from the insights shared by family members and professional instructors during training sessions, we compiled 25 common case scenarios. Using accessible language and vivid illustrations, this handbook seeks to introduce readers to BPSD and possible coping strategies in a practical and engaging way.

Our training program has been well-received by both family members and professionals in the long-term care and healthcare sectors. One family caregiver shared, “I’ve gradually started applying the techniques I learned in everyday life. What I used to find frustrating now makes more sense, and I better understand my family member’s behavior. I no longer get stuck in a cycle of frustration, and this change has improved life for both me and my loved one.” (TV01, daughter caregiver, age 50). A care worker also noted, “I’ve learned a lot. It has helped me adopt a more positive and correct attitude toward caregiving.” (TV05, care attendant, age 64).

Inspired by this feedback, the Dementia Without Losing Spirit handbook was created in hopes of offering practical guidance on managing behavioral symptoms of dementia to family caregivers, professional care providers, and the general public alike.

I would like to express my sincere gratitude to every (family) caregiver who participated in our training courses. Without your strong motivation to learn and your commitment to improving the quality of life for both caregivers and care recipients, we would not have had access to such a rich collection of real-life cases and firsthand insights from the care setting. Finally, my heartfelt thanks go to the leadership of the NHRI for their continued support and dedication to dementia care.

Chia-Ming Yen
Huwei, Yunlin
July 12, 2024

Preface ....................................................................................................................... ii
Acknowledgements ....................................................................................................iii
Common Behavioral and Psychological Symptoms of Dementia (BPSD) Cases and Potential Coping Strategies .................................................................................1
Illustration Descriptions ..............................................................................................2
Case 1: Resistance to Brushing Teeth .......................................................................3
Case 2: Refusal of Care from Nonfamily Caregivers..................................................5
Case 3: Repeated Requests for Food ...................................................................... 11
Case 4: Wandering ...................................................................................................14
Case 5: Decline in Self-Care Abilities .......................................................................17
Case 6: Delirium (Acute Brain Dysfunction) .............................................................19
Case 7: Hallucinations and Delusions ......................................................................22
Case 8: Inability to Tell Time and Date (1) ...............................................................25
Case 9: Inability to Tell Time and Date (2) ...............................................................26
Case 10: Irregular Daily Routines.............................................................................28
Case 11: Unusual Nighttime Behaviors ....................................................................29
Case 12: Repetitive Questioning ..............................................................................30
Case 13: Repeated Purchases.................................................................................31
Case 14: Loss of Interest..........................................................................................33
Case 15: Hoarding....................................................................................................36
Case 16: Refusal to Shower .....................................................................................39
Case 17: Suspicions of Theft (1) ..............................................................................41
Case 18: Suspicions of Theft (2) ..............................................................................42
Case 19: Forgetting Passwords and Insisting on Managing Personal Finances .....44
Case 20: Spitting Saliva ...........................................................................................47
Case 21: Smearing Feces ........................................................................................49
Case 22: Inability to Fasten Buttons .........................................................................51
Case 23: Complaints and Verbal Abuse ...................................................................53
Case 24: Easily Distracted .......................................................................................56
Case 25: Sundown Syndrome ..................................................................................58