Assessment and management of behavioral and psychological symptoms of dementia

Helen C. Kales, Laura N. Gitlin, Constantine G. Lyketsos

Research output: Contribution to journalReview articlepeer-review

402 Scopus citations


Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will a+ ect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size-ts all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used-rst line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to bene-t ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shi1 needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.

Original languageEnglish (US)
Article numberh369
JournalBMJ (Online)
StatePublished - Mar 2 2015

ASJC Scopus subject areas

  • Medicine(all)


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