Behavioral and psychological symptoms of dementia (BPSD) are common in people with dementia, affecting nearly all individuals at some point. These symptoms, including agitation, depression, apathy, and psychosis, are complex, costly, and linked to poor health outcomes, including hospitalization and nursing home placement. They also significantly impact caregivers, causing stress, depression, and reduced quality of life. This review covers the prevalence, types, causes, and management of BPSD, emphasizing community-dwelling patients. BPSD occur in clusters such as psychosis, agitation, aggression, depression, anxiety, apathy, and disinhibition. These symptoms are common across all dementia stages but vary in type and severity. While cognitive decline is the hallmark of dementia, BPSD often dominate both the presentation and progression of the disease. Unlike cognitive deficits, BPSD can fluctuate and last for months. Contributing factors to BPSD include neurobiological, caregiver, and environmental elements. Neurobiological factors involve brain circuits affecting behavior and emotion. Medical conditions, unmet needs, and pre-existing psychiatric illnesses can also contribute. Caregivers face high stress and lower well-being, and environmental factors like overstimulation or lack of routine can exacerbate symptoms. Non-pharmacologic treatments, such as behavioral, environmental, and caregiver interventions, are recommended as first-line approaches. These include problem-solving strategies, environmental modifications, and caregiver support. While some evidence supports the effectiveness of music therapy and physical activity, more high-quality studies are needed. Antipsychotics show limited efficacy and significant adverse effects, including increased mortality risk. Atypical antipsychotics may be more effective for certain symptoms but still carry risks. Antidepressants and mood stabilizers have mixed evidence, with some showing limited benefit. Cholinesterase inhibitors and memantine may offer small improvements but are not always clinically significant. A standardized, evidence-based approach is needed to assess and manage BPSD, integrating pharmacological and non-pharmacological treatments. The DICE model (describe, investigate, create, evaluate) is proposed as a framework for this. This approach emphasizes proactive management over reliance on psychoactive drugs and emergency care.Behavioral and psychological symptoms of dementia (BPSD) are common in people with dementia, affecting nearly all individuals at some point. These symptoms, including agitation, depression, apathy, and psychosis, are complex, costly, and linked to poor health outcomes, including hospitalization and nursing home placement. They also significantly impact caregivers, causing stress, depression, and reduced quality of life. This review covers the prevalence, types, causes, and management of BPSD, emphasizing community-dwelling patients. BPSD occur in clusters such as psychosis, agitation, aggression, depression, anxiety, apathy, and disinhibition. These symptoms are common across all dementia stages but vary in type and severity. While cognitive decline is the hallmark of dementia, BPSD often dominate both the presentation and progression of the disease. Unlike cognitive deficits, BPSD can fluctuate and last for months. Contributing factors to BPSD include neurobiological, caregiver, and environmental elements. Neurobiological factors involve brain circuits affecting behavior and emotion. Medical conditions, unmet needs, and pre-existing psychiatric illnesses can also contribute. Caregivers face high stress and lower well-being, and environmental factors like overstimulation or lack of routine can exacerbate symptoms. Non-pharmacologic treatments, such as behavioral, environmental, and caregiver interventions, are recommended as first-line approaches. These include problem-solving strategies, environmental modifications, and caregiver support. While some evidence supports the effectiveness of music therapy and physical activity, more high-quality studies are needed. Antipsychotics show limited efficacy and significant adverse effects, including increased mortality risk. Atypical antipsychotics may be more effective for certain symptoms but still carry risks. Antidepressants and mood stabilizers have mixed evidence, with some showing limited benefit. Cholinesterase inhibitors and memantine may offer small improvements but are not always clinically significant. A standardized, evidence-based approach is needed to assess and manage BPSD, integrating pharmacological and non-pharmacological treatments. The DICE model (describe, investigate, create, evaluate) is proposed as a framework for this. This approach emphasizes proactive management over reliance on psychoactive drugs and emergency care.