Clinical Practice Guidelines for Dementia: Recommendations for the Pharmacological Treatment of Behavioral and Psychological Symptoms

Gihwan Byeon; Dong Woo Kang; Yeshin Kim; Geon Ha Kim; Ko Woon Kim; Hee-Jin Kim; Seunghee Na; Kee Hyung Park; Young Ho Park; Jeewon Suh; Joon Hyun Shin; YongSoo Shim; YoungSoon Yang; Yoo Hyun Um; Seong-Il Oh; Sheng-Min Wang; Bora Yoon; Sun Min Lee; Juyoun Lee; Jin San Lee; Hak Young Rhee; Jae-Sung Lim; Young Hee Jung; Juhee Chin; Hyemin Jang; Yun Jeong Hong; Miyoung Choi; Jae-Won Jang; Korean Dementia Association’s Quality Management Committee

doi:10.12779/dnd.2025.24.1.24

Clinical Practice Guidelines for Dementia: Recommendations for the Pharmacological Treatment of Behavioral and Psychological Symptoms

Dement Neurocogn Disord. 2025 Jan;24(1):24-43. doi: 10.12779/dnd.2025.24.1.24. Epub 2025 Jan 20.

Authors

Gihwan Byeon¹, Dong Woo Kang¹, Yeshin Kim², Geon Ha Kim³, Ko Woon Kim⁴, Hee-Jin Kim⁵, Seunghee Na⁶, Kee Hyung Park⁷, Young Ho Park⁸, Jeewon Suh⁹, Joon Hyun Shin¹⁰, YongSoo Shim¹¹, YoungSoon Yang¹², Yoo Hyun Um¹³, Seong-Il Oh¹⁴, Sheng-Min Wang¹⁵, Bora Yoon¹⁶, Sun Min Lee¹⁷, Juyoun Lee¹⁸, Jin San Lee¹⁴, Hak Young Rhee¹⁹, Jae-Sung Lim²⁰, Young Hee Jung²¹, Juhee Chin²², Hyemin Jang²³, Yun Jeong Hong²⁴, Miyoung Choi²⁵, Jae-Won Jang²; Korean Dementia Association’s Quality Management Committee

Affiliations

¹ Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
² Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea.
³ Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
⁴ Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
⁵ Department of Neurology, Hanyang University Hospital, Seoul, Korea.
⁶ Department of Neurology, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea.
⁷ Department of Neurology, College of Medicine, Gachon University Gil Medical Center, Incheon, Korea.
⁸ Department of Neurology, Seoul National University Bundang Hospital, Seoul, Korea.
⁹ Department of Neurology, National Medical Center, Seoul, Korea.
¹⁰ Dr Shin's Neurology Clinic, Wonju, Korea.
¹¹ Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
¹² Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
¹³ Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹⁴ Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
¹⁵ Department of Psychiatry, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea.
¹⁶ Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹⁷ Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
¹⁸ Department of Neurology, Chungnam National University Hospital, Daejeon, Korea.
¹⁹ Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
²⁰ Department of Neurology, Asan Medical Center, Seoul, Korea.
²¹ Department of Neurology, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea.
²² Department of Psychology,Doheon Academy, Hallym University, Chuncheon, Korea.
²³ Department of Neurology, Seoul National University Hospital, Seoul, Korea.
²⁴ Department of Neurology, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea.
²⁵ Division of Healthcare Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.

Abstract

Background and purpose: Dementia often accompanies behavioral and psychological symptoms of dementia (BPSD), including agitation, aggression, depression, and psychosis, which impact patients' quality of life and caregiver burden. Effective management of BPSD is essential to support patient and caregiver well-being. This study presents evidence-based clinical practice guidelines for pharmacological treatments of BPSD in dementia, focusing on antipsychotics, antidepressants, cognitive enhancers, and other medications.

Methods: This guideline was developed by the Korean Dementia Association's Quality Management Committee. Key questions were framed using the Population, Intervention, Comparison, Outcome methodology, followed by systematic literature searches. Randomized controlled trials were assessed for quality, and recommendations were graded based on evidence levels, employing the Grading of Recommendations, Assessment, Development and Evaluation system to establish strength and applicability.

Results: Recommendations vary by medication type and symptom severity. Antipsychotics, such as risperidone, are conditionally recommended for managing aggression and psychosis in dementia, while antidepressants, specifically citalopram, are advised for agitation in Alzheimer's disease. Cognitive enhancers, including cholinesterase inhibitors and memantine, showed moderate efficacy for general BPSD improvement and rapid eye movement sleep behavior disorder in Lewy body dementia. Specific drugs, like pimavanserin, demonstrated efficacy in addressing psychosis in Alzheimer's patients.

Conclusions: These guidelines provide a structured approach to pharmacological management of BPSD in dementia, addressing efficacy and safety profiles across drug categories. The recommendations emphasize personalized treatment plans to optimize therapeutic outcomes while minimizing risks, with a conditional approach suggested in cases with limited evidence.

Keywords: Behavioral Symptoms; Dementia; Drug Therapy; Guideline.