Memory Digest

Treating Behavioral Symptoms

How doctors and families approach agitation, anxiety, depression, sleep problems, hallucinations and other behavior changes in dementia, starting with causes and non-drug strategies and using medicines carefully when needed.

Last reviewed: October 2026

For many families, the hardest part of dementia isn't memory loss. It's the changes in behavior and mood: agitation, restlessness, anxiety, suspicion, depression, sleeplessness, or seeing things that aren't there. Doctors sometimes call these "behavioral and psychological symptoms of dementia."

These symptoms are common, they are part of the disease, and they can often be eased. This article explains how treatment usually works. For hands-on tips you can use today, see Managing Challenging Behaviors.

Why behavior changes happen

As dementia damages the brain, it becomes harder for a person to make sense of the world, express needs, and control reactions. The Alzheimer's Association explains that behavior changes are often triggered by something in the person's surroundings, health or routine. Common triggers include:

• Physical discomfort: pain, hunger, thirst, constipation, a full bladder, being too hot or cold
• Illness: infections, especially urinary tract infections, can cause sudden confusion (see Delirium vs. Dementia)
• Medicine side effects or interactions (see Medications That Can Affect Memory)
• Overstimulation: noise, crowds, clutter, too many people talking
• Changes: a new caregiver, a move, travel, or a hospital stay
• Tasks that feel too hard, or feeling rushed
• Fear, boredom or loneliness

Step 1: Look for the cause

Before any medicine, the first job is detective work. The National Institute on Aging (NIA) and the Alzheimer's Association both recommend:

• See the doctor to rule out pain, infection, dehydration, constipation, vision or hearing problems, and medication effects.
• Keep a simple log. Note what happened, when, where, who was there, and what came just before. Patterns often appear, such as agitation every afternoon (see Sundowning) or during bathing.
• Ask what need the behavior is expressing. Pacing might mean pain or boredom. Resisting a bath might mean fear of falling or feeling cold.

Step 2: Non-drug approaches come first

The Alzheimer's Association says non-drug strategies should be tried first. Approaches that often help:

• Stay calm and reassuring. Speak slowly and softly; your mood is contagious.
• Don't argue or correct. Respond to the feeling, not the facts: "You sound worried. I'm here."
• Simplify tasks and choices, and break them into small steps.
• Redirect to a pleasant activity: music, a walk, folding towels, looking at photos.
• Keep a steady routine, with regular times for meals, activity and rest.
• Adjust the setting: reduce noise, improve lighting, remove clutter.
• Build in meaningful activity and exercise during the day, which can also improve sleep.

Research-backed options also include Music and Art Therapy, structured activities, and caregiver training programs. See Non-Drug Treatments for Dementia.

Step 3: Treat specific symptoms

Depression and anxiety. These are common in dementia and are treatable. Doctors may suggest counseling, more activity and social contact, and sometimes an antidepressant. See Personality and Mood Changes.

Sleep problems. Daytime light, activity, limited naps and a calm bedtime routine come first. Many sleeping pills can worsen confusion and raise fall risk in older adults, so ask the doctor before using any, including over-the-counter sleep aids. See Sleep Problems in Dementia.

Hallucinations and delusions. If they aren't upsetting the person, they may not need medicine. Check vision and hearing, reduce shadows and reflections, and offer reassurance. People with Lewy Body Dementia can be extremely sensitive to antipsychotic drugs, so the type of dementia matters. See Hallucinations and Delusions.

Agitation and aggression. When behavior is severe, distressing, or a danger to the person or others, medicine may be considered alongside non-drug care. See Agitation and Aggression.

Medicines: what's available

The Alzheimer's Association lists medicines doctors may use for behavior symptoms. Two are FDA-approved specifically for agitation associated with dementia due to Alzheimer's disease:

• Brexpiprazole (Rexulti), approved in 2023. It is an antipsychotic, and like others in its class it carries a boxed warning about a higher risk of death in older adults with dementia-related psychosis.
• Dextromethorphan-bupropion (Auvelity), approved in April 2026 as the first non-antipsychotic medicine for this use. The FDA lists side effects including dizziness, headache, diarrhea and drowsiness, and warns it can cause seizures and raise blood pressure.

Other medicines, including antidepressants and other antipsychotics, are sometimes prescribed "off label." All of these carry risks. See Antipsychotics and Dementia: Risks for a detailed look.

Using medicine safely

If the doctor suggests a medicine, ask:

1. What symptom is this meant to treat, and how will we know it's working?
2. What side effects should we watch for, such as falls, sleepiness, or more confusion?
3. What's the lowest dose, and how long should we try it?
4. When will we review whether it's still needed?

Experts generally advise starting low, going slow, and checking regularly whether the medicine can be reduced or stopped. Medicines work best when non-drug strategies continue alongside them.

Caring for the caregiver

Living with difficult behaviors is exhausting. Getting breaks, support and training is part of treatment, not a luxury. See Caregiver Stress and Burnout and Respite Care, or call the Alzheimer's Association 24/7 Helpline at 800-272-3900.

Get emergency help (call 911) if anyone is in immediate danger. Let responders know the person has dementia.

Sources

1. Alzheimer's Association: Treatments for Behavior
2. National Institute on Aging: Managing Personality and Behavior Changes in Alzheimer's
3. U.S. Food and Drug Administration: FDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer's Disease (2023)
4. U.S. Food and Drug Administration: FDA Approves First Non-Antipsychotic Drug to Treat Agitation Associated with Dementia (April 30, 2026)

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Managing Challenging Behaviors
• Agitation and Aggression
• Antipsychotics and Dementia: Risks
• Hallucinations and Delusions
• Sundowning