Difficult behaviors in long-term care patients with dementia

J Am Med Dir Assoc. 2007 Mar;8(3 Suppl 2):e101-13. doi: 10.1016/j.jamda.2006.12.012.


Difficult behaviors are relatively common challenges that can occur throughout the natural progression of dementia, but are particularly common in the mid to late stages of disease. These behaviors can be challenging to manage in nursing and assisted care facilities, and can cause distress to the caregivers and to the patients themselves. Our ability to manage these symptoms can have a profound effect on the patient's quality of life. This article reviews the appropriate assessment of behavioral and psychological symptoms of dementia (BPSD) and the literature supporting various nonpharmacologic and pharmacologic treatments. Nonpharmacologic approaches should be the initial focus for treatment of most BPSD, but should these prove inadequate, a variety of medications are available with varying degrees of clinical research to support their use in ameliorating BPSD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Activities of Daily Living
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Antipsychotic Agents / therapeutic use
  • Behavior Therapy / methods
  • Behavioral Symptoms / diagnosis
  • Behavioral Symptoms / etiology*
  • Behavioral Symptoms / therapy*
  • Cholinesterase Inhibitors / therapeutic use
  • Dementia / complications*
  • Dementia / therapy*
  • Depression / etiology
  • Depression / therapy
  • Humans
  • Long-Term Care / methods*
  • Medical History Taking / methods
  • Physical Examination / methods
  • Practice Guidelines as Topic
  • Professional-Patient Relations
  • Receptors, N-Methyl-D-Aspartate / antagonists & inhibitors
  • Sexual Behavior
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / therapy


  • Anticonvulsants
  • Antidepressive Agents
  • Antipsychotic Agents
  • Cholinesterase Inhibitors
  • Receptors, N-Methyl-D-Aspartate