Behavioral and Psychiatric Symptoms of Dementia

Research indicates that the behavioral and psychiatric symptoms of dementia (BPSD) are a major source of caregiver stress and burnout. BPSD affects approximately 90% of all dementia subjects and is associated with a range of poor outcomes, including “distress to patient and caregiver, long term hospitalization, misuse of medication, and increased health care costs” (Cerejeira, Lagarto, & Mukaetova-Ladinska, 2012, p. 1). The majority of care of Alzheimer’s patients is provided by family members in the home. In fact, in 2012 15.4 million family caregivers provided an estimated 17.5 million hours of unpaid care (2013 Alzheimer’s Disease Facts and Figures). Therefore, it is critical that these front line caregivers possess the necessary knowledge, resources, and skills to execute behavioral management effectively.

Behaviors and psychiatric symptoms associated with Alzheimer’s disease and other dementia can include some, any, or all of the following:

  • Agitation
  • Repetitive actions
  • Delusions
  • Hallucinations
  • Wandering
  • Anxiety
  • Dis-inhibition
  • Irritability
  • Depression

Although perhaps troubling, behavioral  and psychiatric changes can be effectively managed with proper techniques. However, this is certainly a challenging feat. The caregiver must be flexible in their approach; as the person with dementia progresses, the strategies the caregiver implements must accommodate cognitive changes.

Research studies on this topic recommend employing non-pharmacological strategies to behavioral management. Some of these strategies include:

  • Analyze for causes of disruptive behavior (e.g. pain, medical illness, fatigue, depression, loneliness, etc.)
  • Redirecting the person’s attention
  • Reassure the person — use calming phrases
  • Respond to emotion behind statements, rather than the words themselves
  • Modify the environment — decrease noise level and distractions
  • Simplify tasks and routines
  • Allow adequate rest between stimulating events
  • Find outlets for energy — take a walk, do household chores, or go for a car ride


Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012, May 7). Behavioral and psychological symptoms of dementia. Frontiers in       Neurology(73), 1-21. doi:10.3389/fneur.2012.00073

Farran, C. J., Fogg, L. G., McCann, J. J., Etkin, C., Dong, X., & Barnes, L. L. (2012, May 1). Assessing family caregiver skill in managing behavioral symptoms of Alzheimer’s disease. Aging Mental Health15(4), 510-521. doi:doi:10.1080/13607863.2010.536140

Shaji, K. S., George, R. K., Prince, M. J., & Jacob, K. S. (2009). Behavioral symptoms and caregiver burden in dementia. Indian Journal of Psychiatry51(1), 45-49. doi:10.4103/0019-5545.44905

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