BPSD

Behavioral and Psychological Symptoms of Dementia (BPSD) refer to a range of non-cognitive symptoms that commonly accompany dementia. BPSD is not a specific diagnosis and can occur across forms of dementia, including Alzheimer's disease and vascular dementia.

Typical manifestations include agitation, aggression, wandering, delusions, hallucinations, depression, anxiety, apathy, irritability, disinhibition, sleep disturbance, and eating or appetite changes.

BPSD is highly prevalent, especially as dementia progresses. Estimates vary, but behavior and mood symptoms affect the majority of people with moderate to severe dementia and can contribute to functional decline or the need for supervision.

Causes are multifactorial and include neurodegenerative brain changes, sensory impairment, pain, infection, metabolic disturbances, medication effects, and environmental or social triggers. Unmet needs and caregiver stress, along with routine changes, can precipitate or worsen symptoms.

Assessment relies on history from caregivers and clinician observations. Structured tools such as the Neuropsychiatric Inventory (NPI) document frequency, severity, and distress. Delirium and mood disorders should be ruled out.

Management emphasizes nonpharmacologic, person-centered approaches as first line. Environmental modification, routines, activities, sleep optimization, and caregiver training can reduce burden. When symptoms are severe, pharmacologic treatment is considered cautiously with regular reassessment.

Antipsychotics may be prescribed for short periods to manage severe agitation or psychosis but carry mortality risk and require risk-benefit evaluation and monitoring. Antidepressants or anxiolytics may help with mood or anxiety symptoms.

BPSD can elevate caregiver burden and risk of institutionalization. Symptoms may fluctuate and respond to treating underlying triggers, though some patients experience persistent changes requiring ongoing support.

Guidelines emphasize nonpharmacologic care and cautious use of medications, with individualized plans and caregiver education.