What Are the Behavioral and Psychological Symptoms of Dementia (BPSD)?

Behavioral and psychosocial symptoms of dementia (BPSD), or neuropsychiatric symptoms, are general terms used in the field of Alzheimer's disease and dementia to describe the challenging behaviors of dementia.

Senior woman covering face with her hands
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Isn't Dementia a Cognitive Disorder?

Yes. It's a condition where the functioning of the brain deteriorates, causing impaired ability to think and interact appropriately with others and the environment. This brain deterioration frequently causes personality, behavioral, psychological, and emotional changes, which can be referred to as BPSD.

Symptoms of BPSD

Symptoms of BPSD include:

  • Agitation
  • Restlessness, pacing and wandering
  • Anxiety
  • Elation
  • Irritability
  • Depression
  • Apathy
  • Disinhibition
  • Delusions
  • Hallucinations
  • Sleep or appetite changes

How Common Are BPSD Symptoms?

The most common BPSD symptoms include apathy and agitation, irritability, sleep and appetite disorders, and mood disorders. In a 2017 study, 99.1% of 107 patients exhibited at least one BPSD symptom and 71% had four symptoms. These symptoms can be very frustrating and challenging for patients and their caregivers.

Treatment Options for BPSD Symptoms

In many cases, non-drug approaches are the safest and most effective way to manage these symptoms. Strategies such as attempting to determine the cause of the behavior and meet or prevent that need can be very effective at times.

For example, is the person pacing, wandering, and agitated because he is experiencing boredom and loneliness? Then we need to provide him with meaningful activities, not just a bingo game. Is she unsafely trying to get up out of her chair repeatedly? We need to determine if she needs to use the bathroom or stretch her legs by going for a walk with you.

In other situations, medications might be more appropriate. For example, if someone is experiencing distressing hallucinations, delusions, or paranoia, an antipsychotic medication might be appropriate to relieve the distress. However, these medications do have the potential for significant side effects, so careful monitoring is a must.

4 Sources
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  2. Hugo J, Ganguli M. Dementia and cognitive impairment: epidemiology, diagnosis, and treatment. Clin Geriatr Med. 2014;30(3):421-442. doi: 10.1016/j.cger.2014.04.001

  3. Mukherjee A, Biswas A, Roy A, Biswas S, Gangopadhyay G, Das SK. Behavioural and psychological symptoms of dementia: correlates and impact on caregiver distress. Dement Geriatr Cogn Disord Extra. 2017;7(3):354-365. doi: 10.1159/000481568

  4. Ohno Y, Kunisawa N, Shimizu S. Antipsychotic treatment of behavioral and psychological symptoms of dementia (Bpsd): management of extrapyramidal side effects. Front Pharmacol. 2019;10:1045. doi: 10.3389/fphar.2019.01045

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.