Pharmacological Management of Neuropsychiatric Symptoms in Dementia

Neuropsychiatric symptoms in dementia encompass a spectrum of behavioural and psychological disturbances, including agitation, aggression, psychosis, mood disorders and apathy. While non-pharmacological interventions remain first-line, pharmacological approaches are frequently employed when symptoms pose risk to patients or carers. Cholinesterase inhibitors and memantine offer modest benefits for cognitive and behavioural dimensions, but most targeted pharmacotherapy relies on antipsychotics, antidepressants, mood stabilisers and anxiolytics. Atypical antipsychotics such as risperidone, quetiapine and aripiprazole are often used to control agitation or psychotic features, yet these agents carry significant cerebrovascular and cardiovascular risks, especially early after initiation. Antidepressants—particularly selective serotonin reuptake inhibitors—are considered for patients with prominent depression or agitation, with evidence suggesting modest efficacy for citalopram. Benzodiazepines and anticonvulsants are less favoured due to sedation, falls and cognitive worsening. Contemporary research aims to refine benefit-risk profiles, individualise treatment according to symptom clusters and explore emerging compounds with novel mechanisms. Policymakers and clinicians worldwide stress the importance of regular review, dose minimisation and treatment discontinuation once clinical stability is achieved. Integrating pharmaco-therapeutic strategies within multidisciplinary care pathways can mitigate adverse outcomes and enhance quality of life for people living with dementia.

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Pharmacological Management of Neuropsychiatric Symptoms in Dementia publication trend

The graph below shows the total number of articles in pharmacological management of neuropsychiatric symptoms in dementia across all publications each year (not limited to Nature Index journals).

Technical terms

Neuropsychiatric symptoms (NPS): Behavioural and psychological disturbances—such as agitation, psychosis and depression—commonly occurring in dementia.

Antipsychotic: A class of medications (typical and atypical) used to treat psychosis and agitation, acting on dopamine and other neurotransmitter systems.

Agitation: Excessive motor activity and emotional distress in dementia, often manifesting as restlessness, irritability or aggression.

Network meta-analysis: A statistical method that compares multiple treatments simultaneously by pooling direct and indirect evidence across clinical trials.

References

1. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. The BMJ (2024).
2. Physician Antipsychotic Overprescribing Letters and Cognitive, Behavioral, and Physical Health Outcomes Among People With Dementia. JAMA Network Open (2024).
3. Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis. Frontiers in Aging Neuroscience (2023).