Intended for healthcare professionals

Practice Essentials

Ward based management of behavioural and psychological symptoms of dementia

BMJ 2021; 374 doi: (Published 04 August 2021) Cite this as: BMJ 2021;374:n1779
  1. Jenny Nguyen, final year medical student1,
  2. Ina Ko, fifth year medical student1,
  3. Santiago Martinez-Sosa, , foundation year 2 doctor2,
  4. Ruth Mizoguchi, care of the elderly consultant and dementia lead3
  1. 1Imperial College London, London, UK
  2. 2Ealing Hospital, London, UK
  3. 3Chelsea & Westminster NHS Foundation Trust, London, UK
  1. Correspondence to J Nguyen jn1315{at}

What you need to know

  • Behavioural and psychological symptoms of dementia (BPSD) can be exacerbated by a plethora of underlying reversible factors (eg, poor pain control)

  • Identifying possible environmental or clinical triggers for a patient’s symptoms is the main aim of assessment in someone with an exacerbation of BPSD

  • Non-pharmacological interventions, such as managing environmental factors, are first line and should be tailored to the individual patient

  • When considering pharmacological intervention, focus on medications with evidence of benefit in BPSD. Drug interventions will not be able to address all symptoms

  • Pharmacological sedation should only be used in emergency situations

An 81 year old woman with vascular dementia has been admitted to the hospital following a fall in the community and is currently an inpatient on the ward. You are the doctor on call and have been asked to review the patient as she appears more confused and is trying to leave the ward.

Worldwide, dementia affects 50 million people, with a predicted increase to 82 million by 2030.1 Dementia is characteristically progressive and severely affects activities of daily living.

Behavioural and psychological symptoms of dementia (BPSD) refer to a cluster of symptoms of dementia relating to perception, mood, thought content, or behaviour.2 They are associated with increased care costs and are important prognosticators of admission to nursing homes. It is estimated that more than 80% of people with dementia will experience BPSD during the course of the disease.3

BPSD are challenging to manage for patients, carers, and healthcare workers, but effective management can substantially improve quality of life for both patients and carers.

As people with dementia make up a relatively high proportion of hospital inpatients, clinicians working in an acute setting are likely to encounter BPSD often.

This article aims to introduce clinicians to BPSD, their key triggers in an inpatient …

View Full Text

Log in

Log in through your institution


* For online subscription