Although cognitive impairment is the clinical hallmark of dementia, behavioral and psychological signs and symptoms of dementia (BPSD), which are also known as non-cognitive neuropsychiatric symptoms (NPS), are extremely common and are responsible for the majority of pain and suffering experienced by the individuals living with dementia and those who love and care for them. In addition, BPSD is a primary factor responsible for the medical and other costs associated with caring for individuals living with dementia. BPSD accounts for at least 30% percent of the cost of caring for community dwelling individuals with dementia.

Research has found that BPSD is associated with:

1)Reduced quality of life for patients living with dementia,

2)Reduced quality of life for family members and caregivers, 

3)Early nursing home placement,

4)Hospital admissions,

5)Avoidable morbidity and mortality,

6)Caregiver stress and depression,

7)Reduced caregiver employment income.

The assessment and treatment of BPSD is not simple. BPSD is the result of the interaction of numerous possible factors that are internal and external to the individual living with dementia, including the brain disease responsible for the dementia and the environment in which the individual is living.

Recently, a number of groups and organizations have developed and published excellent algorithms, treatment guidelines and other resources to help clinicians and family members accurately diagnose and treat BPSD. The goal of this section in the full Guidelines is to succinctly summarize previously developed information with references so that the treating provider can easily obtain additional and more detailed information when necessary, and so that the provider knows when to seek consultation from a specialist in this area. Specifically, this guide contains an assessment and treatment algorithm, a number of guidelines for assessing and treating some of the most common forms of BPSD, and a form for caregivers to use when preparing to meet with a clinician in order to obtain help with BPSD.

Once a diagnosis is made, both behavioral/environmental and pharmacologic interventions may be needed over the course of the disease. Tools below assist physicians to address the needs of patients and their caregivers.

DICE: Describe, Investigate, Create, Evaluate.

Behavioral and Environmental Management of BPSD

Pharmacologic Management of BPSD

Algorithm for Disease Management

Algorithm for Agitation and Aggression

Algorithm for Depression

Algorithm for Sleep Problems

Algorithm for Wandering

Instrumental Activities of Daily Living

Preparation for Doctor’s Visit

End of Life Planning and Care