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Behavioral and Psychological Symptoms of Dementia (BPSD)

Behavioral and Psychological Symptoms



Carers of the persons with dementia find behavioral symptoms to be the most challenging and distressing effects of the disease. It is important for the carers to recognize the symptoms, understand the cause and know the treatment options.


Common BPSD in different stage of dementia





Early stage

  • Irritability

  • Anxiety

  • Depression


Middle and late stage

  • Sleep disturbances

  • Physical or verbal outbursts

  • Emotional distress

  • Restlessness, pacing, shredding paper or tissues and yelling or wandering

  • Delusions (firmly held belief in things that are not real)

  • Hallucinations (seeing, hearing or feeling things that are not there)



  • Aggression

  • Anxiety or agitation

  • Confusion

  • Repetition

  • Suspicion

  • Bold behavior

  • Inappropriate dressing

  • Shoplifting
    Persons with dementia can act in different and unpredictable ways. It is important to remember that the person is not acting this way on purpose. Whatever the behavior, try to identify the cause and possible solution.



  • progressive deterioration of brain cells

  • medication and medical condition
    Side effects of prescription medication are another common contributing factor to behavioral symptoms. Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions, as that creates the potential for drug interactions. Anyone experiencing behavioral symptoms should receive a thorough medical evaluation, especially when symptoms appear suddenly. Examples of treatable conditions that can trigger behavioral symptoms include infections of the ear, sinuses, urinary or respiratory tracts; constipation; and uncorrected problems with hearing or vision.

  • environmental influences
    - unfamiliar surroundings, such as moving to a new residence or nursing home
    - changes in the environment or caregiver arrangements
    - misperceived treats

  • Physical discomfort

  • Overstimulation

  • Complicated tasks

  • Frustrating interactions: inability to communicate effectively






With proper treatment, symptoms can be significantly reduced and stabilized. Successful treatment depends on recognizing which symptoms the person is experiencing, making a careful assessment and identifying possible causes of the symptoms. Treatment often takes a two-pronged approach: non-drug treatment strategies and prescription medication. Non-drug approaches should always be tried first.


  • Non-drug treatment strategies
    - Identifying the symptom
    - Understanding its cause
    - Adapting the caregiving environment to remedy the situation


Correctly identifying the cause can help in selecting the best intervention. Often, the trigger of behavior is some sort change in the person's environment, such as change in carer or in living arrangements; travel; admission to hospital; presence of house guests; or being asked to bathe or change clothing.


A key principle of intervention is redirecting the person's attention, rather than arguing or being confrontational.



More tips:

  • simplifying the environment, tasks and routines

  • allowing adequate rest between stimulating events

  • using labels to cue or remind the person

  • increasing the safety of the environment by equipping doors and gates with locks, and removing weapons

  • using lighting to reduce confusion and restlessness at night



Tips for preventing agitation

  • create a calm environment

  • remove stressors, triggers or danger

  • move the person to a safer or quieter place

  • offer a security object, rest or privacy

  • provide an opportunity for exercise

  • avoid environmental triggers, such as noise, glare and too much background distraction, including television.

  • Monitor the person's personal comfort by checking for pain, hunger, thirst, constipation, full bladder, infections and skin irritation ensure a comfortable temperature; be sensitive to fears and frustration with expressing what is wanted.


  • Antidepressant medications

  • Antipsychotic medications

  • Anti-anxiety drugs

  • Medication for sleep problems

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