Patients with dementia including Alzheimer's disease sometimes present aggressiveness, excitement, delusions, so called as BPSD (behavioral and psychological symptoms of dementia), which can be problematic in clinical settings. Antipsychotics have been often used for the management of challenging BPSD. However, in 2005, a meta-analysis reported that the mortality rate of the group receiving atypical antipsychotics increased 1.6 to 1.7 times, and the FDA issued a warning for these drugs. The 2016 APA guidelines state that it should be used after careful consideration of risks and benefits. In Japan, there are no strong regulations against antipsychotics to patients with dementia. One study reported that typical antipsychotics drugs are decreasing, but the use of atypical antipsychotics are increasing in Japan. A large-scale cohort study in Japan reported that a newly antipsychotic administered group have 2.5 times risk of death after 11 weeks. Therefore, the 2017 Guidelines for dementia also give priority to non-pharmacological management for BPSD. Non-pharmacological management prior to pharmacological invention is considered to be a consensus, but there is no non-pharmacological management with sufficient evidence for BPSD. It is important to review subject's symptoms, reconsider the diagnosis, and consider other physical conditions and psychosocial factors that can affect behaviors when physicians encounter refractory BPSD. The authors are also doing some new researches for treatment of BPSD. The authors did some researches to know the predictors of BPSD's response to antipsychotic administration, that can determine whether antipsychotic are effective before treatment. The authors are also trying to collect knowledge of non-pharmacological management for BPSD. These efforts are important in the future prevention and treatment of BPSD.
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