Clinical Practice Guidelines for Dementia: Recommendations for the Pharmacological Treatment of Behavioral and Psychological Symptoms.

Background and purpose: Dementia often accompanies behavioral and psychological symptoms of dementia (BPSD), including agitation, aggression, depression, and psychosis, which impact patients' quality of life and caregiver burden. Effective management of BPSD is essential to support patient and caregiver well-being. This study presents evidence-based clinical practice guidelines for pharmacological treatments of BPSD in dementia, focusing on antipsychotics, antidepressants, cognitive enhancers, and other medications.

Methods: This guideline was developed by the Korean Dementia Association's Quality Management Committee. Key questions were framed using the Population, Intervention, Comparison, Outcome methodology, followed by systematic literature searches. Randomized controlled trials were assessed for quality, and recommendations were graded based on evidence levels, employing the Grading of Recommendations, Assessment, Development and Evaluation system to establish strength and applicability.

Results: Recommendations vary by medication type and symptom severity. Antipsychotics, such as risperidone, are conditionally recommended for managing aggression and psychosis in dementia, while antidepressants, specifically citalopram, are advised for agitation in Alzheimer's disease. Cognitive enhancers, including cholinesterase inhibitors and memantine, showed moderate efficacy for general BPSD improvement and rapid eye movement sleep behavior disorder in Lewy body dementia. Specific drugs, like pimavanserin, demonstrated efficacy in addressing psychosis in Alzheimer's patients.

Conclusions: These guidelines provide a structured approach to pharmacological management of BPSD in dementia, addressing efficacy and safety profiles across drug categories. The recommendations emphasize personalized treatment plans to optimize therapeutic outcomes while minimizing risks, with a conditional approach suggested in cases with limited evidence.