Drug Interventions for Behavioral and Psychological Symptoms of Dementia: Focus on Aggression

Dementia is a progressive and irreversible neurodegenerative disorder that profoundly impairs cognitive, behavioral, and functional abilities. Beyond cognitive decline, individuals with dementia frequently experience behavioral and psychological symptoms that complicate clinical management and reduce quality of life. Among these symptoms, aggression represents one of the most challenging and disruptive manifestations, affecting approximately 20–30% of patients during the course of the illness. Aggressive behaviors may present as verbal hostility, physical aggression, resistance to care, or socially inappropriate actions, creating significant distress for patients, caregivers, and healthcare professionals. These behaviors are associated with increased caregiver burden, accelerated functional deterioration, higher rates of institutionalization, and rising healthcare expenditures. The development of aggression in dementia is multifactorial, involving interactions between neuropathological changes, unmet physical or emotional needs, environmental triggers, and impaired communication. Neurobiological evidence suggests that aggression is linked to structural and functional alterations in brain regions such as the prefrontal cortex, amygdala, and hippocampus, as well as dysregulation of key neurotransmitter systems including dopamine, serotonin, and acetylcholine. Given the complexity of these mechanisms, pharmacological interventions have been widely explored to mitigate aggressive behaviors in affected individuals. This review examines current pharmacological strategies used in the management of aggression in dementia, including antipsychotics, antidepressants, mood stabilizers, and cholinesterase inhibitors, while also highlighting their clinical effectiveness, safety considerations, and limitations. Understanding these therapeutic options is essential for optimizing patient outcomes and supporting caregivers in the management of behavioral symptoms associated with dementia