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Management of neuropsychiatric symptoms of dementia

Daniel Press, MD
Michael Alexander, MD
Section Editor
Steven T DeKosky, MD, FAAN, FACP, FANA
Deputy Editor
Janet L Wilterdink, MD


Neuropsychiatric symptoms in Alzheimer disease (AD) and other types of dementia are extremely common and often much more troubling than amnestic symptoms. This topic will review the causes and treatment of behavioral disturbance and other neuropsychiatric symptoms related to dementia.

Treatment of the cognitive features of dementia, the approach to safety and societal issues related to dementia, and the palliative care of patients with advanced dementia are discussed separately. (See "Treatment of dementia" and "Frontotemporal dementia: Treatment" and "Prognosis and treatment of dementia with Lewy bodies" and "Treatment and prevention of vascular dementia" and "Safety and societal issues related to dementia" and "Palliative care of patients with advanced dementia".)


Neuropsychiatric symptoms are common in dementia [1,2]. These symptoms include agitation, aggression, delusions, hallucinations, wandering, depression, apathy, disinhibition, and sleep disturbances (table 1). One or more of these symptoms are observed in 60 to 90 percent of patients with dementia; the prevalence increases with disease severity [3-7].

Behavioral disturbances commonly peak in the late afternoon or evening, a phenomenon often referred to as "sundowning." Sundowning affects up to two-thirds of patients with dementia and is closely related to disturbed circadian rhythms [8-12]. Risk factors include poor light exposure and disturbed sleep [13].

Sophisticated neuroimaging techniques are increasingly able to define neuroanatomic substrates for some of these behaviors; in particular, the right hemisphere and right frontal lobe appear important in the mediation of social and emotional behaviors [14].

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Literature review current through: Nov 2017. | This topic last updated: Oct 23, 2017.
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