From the Guidelines

Non-pharmacological treatments are the primary evidence-based approach for managing Behavioral and Psychological Symptoms of Dementia (BPSD).

Non-pharmacological treatments (NPTs) are a diverse range of interventions, including cognitive training, physical exercise, dietary treatments, art-oriented therapy, and reminiscence therapy 1.
These treatments are generally well accepted, have minimal adverse side effects, and can be combined with other NPTs and pharmacological treatments without major concerns around interference 1.

NPTs can be classified in various ways, including by professional discipline, World Health Organization classification of functioning, or by target symptoms (e.g., wandering, BPSD, cognitive impairment) 1.
However, it is challenging to propose a grouping or classification framework for NPTs that is entirely satisfactory or mutually exclusive 1.

While pharmacological treatments are available for dementia, the evidence is insufficient to compare their effectiveness, and there is an urgent need for further research on their clinical effectiveness 1.
The choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication 1.

NPTs have the potential to have a meaningful impact on cognition, well-being, and quality of life throughout the course of age-related neurodegenerative diseases 1.
Clinicians should consider the individual needs and preferences of patients with dementia when selecting NPTs, and involve caregivers and family members in the treatment process whenever possible.

From the Research

The following evidence-based treatments for Behavioral and Psychological Symptoms of Dementia (BPSD) are supported by research:

Non-pharmacological practices, including:
- Sensory practices (aromatherapy, massage, multi-sensory stimulation, bright light therapy) 2
- Psychosocial practices (validation therapy, reminiscence therapy, music therapy, pet therapy, meaningful activities) 2
- Structured care protocols (bathing, mouth care) 2
Training of formal caregivers as the most effective intervention for BPSD 3
Pharmacological interventions, including:
- Antidepressants and antipsychotics as a mainstay of treatment for BPSD 3
- Cholinesterase inhibitors (donepezil and galantamine) for the management of BPSD where non-pharmacological treatments have failed 4
- Analgesics for the management of pain-related BPSD 4

Non-pharmacological interventions are effective in treating BPSD, with evidence supporting the use of:

Functional analysis-based interventions as first-line management of BPSD 4
Music therapy as a potentially beneficial intervention, although further research is required 4
Cognitive stimulation therapy and education of caregivers as effective non-pharmacological techniques 5

Pharmacological interventions should be used judiciously, with consideration of the potential risks and benefits:

Antipsychotics should be prescribed only when behaviors pose a significant safety risk or if the person with dementia is very distressed 3
Antipsychotics have proven effectiveness, but should be avoided where possible due to the high risk of serious adverse events and availability of safer alternatives 4