Management of Behavioral and Psychological Symptoms of Dementia: Nonpharmacologic and Pharmacologic Interventions

Mounting evidence supports the efficacy of nonpharmacologic or psychosocial interventions for reducing behavioral and psychological symptoms of dementia (BPSD), identifies the comparative risks and benefits of psychotropic medication, and underscores the importance of deprescribing psychotropic medications. However, evidence from clinical settings indicates that uptake of nonpharmacologic interventions and potential overuse of medications remain problematic. We begin by discussing the importance of exploring potential contributors to BPSD, using person-centered language to describe BPSD, implementing holistic and person-centered care plans, measuring clinically important changes in BPSD, and considering social determinants of health when assessing and managing BPSD; we also discuss the historical context informing how clinicians manage BPSD. Next, we compare and contrast nonpharmacologic and pharmacologic approaches to managing BPSD, evaluate their individual and comparative efficacy, and describe recommendations for intervention deprescribing or deimplementation. Lastly, we discuss strengths and limitations of the current evidence supporting BPSD management as well as recommendations for future research.