It is increasingly recognized that pharmacological treatments for Behavioral and Psychological Symptoms of Dementia (BPSD) should be used as a second-line approach, and that non-pharmacological options should, in best practice, be pursued first (Douglas, James, & Ballard, 2014; Cheng et al., 2023).

Certain medications, such as antipsychotics, carry black box warnings and are flagged by the Beers Criteria for use in older adults. Despite these well-documented risks to patient health, these medications are still often used as a first-line response.

According to Alves et al. (2013), behavioral symptoms such as repetitive statements and questions, wandering, and sleep disturbances are a core clinical feature of Alzheimer’s disease and related dementias. These symptoms can significantly impact both individuals and their families. If left untreated, they may contribute to more rapid disease progression, earlier nursing home placement, poorer quality of life, accelerated functional decline, greater emotional strain for loved ones, and increased healthcare utilization and costs.

Ongoing, systematic screening for behavioral symptoms is a critical component of comprehensive dementia care, supporting prevention and early intervention. Pharmacological treatments for behavioral symptoms offer only modest benefit, carry notable risks, and often do not address the behaviors that families find most distressing. For these reasons, non-pharmacologic interventions are recommended as the first-line approach or, when necessary, used in combination with medication or other treatments.

Non-pharmacologic interventions may involve a general approach such as caregiver education, communication and problem-solving strategies, task simplification, exercise, or engagement in structured activities. They may also involve more targeted strategies that identify and modify specific triggers for challenging behaviors.

These are all examples of the evidence-based services I offer.