What it is: People with advanced dementia may develop emotional, perceptual, and behavioural disturbances out of step with their character. If these are considered part of the dementia process, then they are commonly known as behavioural and psychological symptoms of dementia (BPSD).
Why it matters: Most people with dementia experience BPSD. This has a negative impact on their quality of life. It also affects carer quality of life. BPSD commonly appears as aggression, agitation, anxiety, depression, or apathy.
What I need to know: Common BPSD symptoms include:
Ongoing staff training to understand and communicate with people with dementia helps. BPSD management should begin with non-pharmacological strategies (that is without medications). A focus on individualised or person-centred care based on the person’s preferences is recommended. For example, music therapy where the person makes choices and engages with the activity. Ask the person or their family what things they do or do not like.
Use of restraint should be minimised. Due to the increased risk of serious adverse events (e.g. falls, fractures, death), for people with mild-to-moderate BPSD antipsychotic medications should be avoided. Antipsychotic medications can be used if the person has severe BPSD, is at immediate risk of harming themself or others, or is in extreme distress. Non-pharmacological approaches should be continued if antipsychotics are used.
A focus on underlying factors rather than the behaviour itself is a more effective way to manage BPSD.
Put in place a behaviour support plan for residents who exhibit responsive behaviours as part of their care and services plan.
Create supportive relationships to promote trust by:
Watch for signs that they agree (smiling, laughing, talking) or disagree (agitation, resistance, restlessness).
Ask prescribers to review medications for side effects.
Seek underlying factors. These include:
Support the person by:
Look for patterns in the behaviours e.g. time of day, a certain activity. Allocate more time for support.
Keep the person physically active if appropriate.
Tools that may be useful include:
Dementia Training Australia Responsive Behaviours Quick Reference Cards
Behaviour Support Plan resources from Dementia Support Australia.
Dementia Behaviour Management Advisory Service (DBMAS) or call 1800 699 799
The ELDAC Dementia toolkit.
What ways have I tried to deal with behavioural and psychological symptoms of dementia?
What worked well and what could have been done better?
What supports does my organisation offer staff and families to manage BPSD? What would be useful?
See related palliAGED Practice Tip Sheets:
Advanced dementia
Anxiety
Person-centred care
CareSearch is funded by the Australian Government Department of Health, Disability and Ageing. Updated May 2025
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