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Assessment and management of behavioral and psychological symptoms of dementia
Kales HC, Gitlin LN, Lyketsos CG.. BMJ (Clinical research ed.), 2015-03-02
Topic: Risk, prevention and care in population studies
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.
Key findings
- Non-pharmacologic approaches should be used first line, although several exceptions are discussed.
- Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions.
- Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern.
- An approach to integrating non-pharmacologic and pharmacologic treatments is described.
- Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.
Why it matters
This review recommends non-drug approaches as first-line treatment for behavioral and psychological symptoms of dementia, with family caregiver interventions having the strongest evidence, while antipsychotics have the strongest drug evidence but a concerning risk-to-benefit ratio. It addresses symptom management, not curing or preventing Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 61/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (BMJ (Clinical research ed.)) |
| Journal's citation record | 3 / 4 | BMJ: journal h-index 413 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 1,231 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 94.7 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 6 / 6 | Cited 60.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 29 other studies in this library |
| Still being cited | 4 / 4 | Cited 329 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Constantine George Lyketsos: h-index 130 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 25731881) |
| Free to read | 2 / 2 | Free to read |
| Total | 61 / 100 | — |
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Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ (Clinical research ed.). https://doi.org/10.1136/bmj.h369
Vancouver
Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ (Clinical research ed.). 2015. doi:10.1136/bmj.h369. PMID: 25731881.
BibTeX
@article{kales2015-25731881,
author = {Kales, H. C. and Gitlin, L. N. and Lyketsos, C. G.},
title = {{Assessment and management of behavioral and psychological symptoms of dementia}},
journal = {BMJ (Clinical research ed.)},
year = {2015},
doi = {10.1136/bmj.h369},
pmid = {25731881},
url = {https://doi.org/10.1136/bmj.h369}
}
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