Managing Behavioral and Psychological Symptoms of Dementia 

Author: Shanila Huerta, Morehouse School of Medicine PA-S

Dementia is most often recognized for its effect on memory, but many families are surprised when behavioral and emotional changes appear. These changes, called Behavioral and Psychological Symptoms of Dementia (BPSD), are common and often distressing. They can include agitation, wandering, hallucinations, sleep problems, and mood changes. For patients and caregivers, BPSD can be overwhelming, but the good news is that there are many strategies—non-medication and, when needed, medication—that can help.

Why BPSD Happens?

BPSD does not have a single cause. Instead, it results from a combination of:

• Brain changes: Dementia affects areas of the brain responsible for emotion, behavior, and judgment ¹
• Physical health issues, such as pain, infections, constipation, dehydration, or side effects of medications, may trigger or exacerbate symptoms.²
• Unmet needs: such as loneliness, boredom, or a lack of stimulation, can manifest as agitation or withdrawal.¹
• Environmental factors, such as overstimulation, noisy settings, poor lighting, or sudden changes in routine, may contribute.²

By identifying triggers, caregivers can often reduce or prevent certain behaviors.

First Line Care (No Medications) for BPSD

These strategies are safer and can be very effective when tailored to the individual.

1. Modify the Environment

• Reduce noise and clutter.
• Keep lighting consistent to reduce shadows (which can trigger fear or confusion).
• Maintain predictable daily routines.²

2. Engage in Meaningful Activity

• Offer music, art, puzzles, gardening, or folding laundry.
• Encourage gentle exercise or walks outdoors.
• Use activities that connect to the person’s past roles or hobbies.³

3. Improve Communication

• Speak slowly and calmly, with simple sentences.
• Use visual cues (pictures, labels, calendars).
• Validate emotions instead of correcting memory mistakes—for example, respond to the feeling rather than the accuracy of the statement.⁴

4. Promote Healthy Sleep

• Keep a consistent sleep-wake cycle.
• Limit caffeine and long naps.
• Ensure comfort and safety at night.¹

5. Caregiver Support

Caregivers often feel isolated or overwhelmed. Education, respite care, and support groups are essential to reduce burnout and maintain patient safety.³

When Medications May Be Needed

If BPSD symptoms cause severe distress or safety risks, medications may be considered—but always with caution.

• Antipsychotics (e.g., risperidone) can reduce aggression, agitation, or psychosis, but carry risks including falls and higher mortality.²
• Antidepressants may help with depression, anxiety, or irritability.²
• Cognitive enhancers (donepezil, memantine) sometimes help improve both cognition and some behaviors.²

Medication decisions should be individualized, closely monitored, and time-limited when possible, using the lowest effective dose ^2,5. It is important to follow up closely with your Primary Care Provider or Psychiatrist.

Stepwise Approach

A simple guide to follow that families can use to manage Behavioral and Psychological Symptoms of Dementia

1. Assess the cause: Check for medical issues (such as pain, infection, constipation, medications that may be causing BPSD).
2. Address environment and routine: Simplify tasks, provide comfort, reduce overstimulation.
3. Use non-medication approaches first: Activities, music, reassurance, structured routines.
4. Support the caregiver: Education, support groups, respite. (Have a greater likelihood of experiencing burnout)
5. Consider medications cautiously if symptoms are dangerous or severely disruptive.

CONCLUSION

BPSD can be one of the most challenging aspects of dementia, but it is also manageable. By focusing on environment, empathy, and routine first, and using medications only when necessary, families can help reduce symptoms, improve safety, and protect dignity.

Takeaway: When behaviors become difficult, pause and ask: “What need is not being met?”

Respond with empathy, structure, and support. Small changes can make a big difference for both patients and caregivers.

Author: Shanila Huerta, Morehouse School of Medicine PA-S

References

Cloak N, Al Khalili Y. Behavioral and Psychological Symptoms in Dementia. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Accessed September 14, 2025. https://www.ncbi.nlm.nih.gov/books/NBK551552/

Byeon G. Clinical practice guidelines for dementia: Effective management of behavioral and psychological symptoms. Dement Neurocognitive Disord. 2025;24(1):1-24. doi:10.12779/dnd.2025.24.1.24

ADRC Wisconsin. Best practices in the care of patients with behavioral and psychological symptoms of dementia. Published 2024. Accessed September 14, 2025. https://www.adrc.wisc.edu/news/best-practices-care-patients-behavioral-and-psychological-symptoms-dementia

Verywell Health. Using validation therapy for people with dementia. Accessed September 14, 2025. https://www.verywellhealth.com/using-validation-therapy-for-people-with-dementia-98683

Kim B, Noh GO, Kim K. Behavioural and psychological symptoms of dementia in Alzheimer’s disease and caregiver burden: Path analysis. BMC Geriatr. 2021;21:160. doi:10.1186/s12877-021-02109-w