A substantial number of trials have focused on the effectiveness of atypical antipsychotics for the treatment of behavioral and psychological symptoms of dementia. In total, 18 placebo-controlled randomized controlled trials conducted over a 6- to 12-week period have been undertaken in people with Alzheimer's disease. The best evidence of efficacy for the treatment of agitation, aggression, and psychosis relates to risperidone. Five trials have indicated a modest but significant improvement in aggression and psychosis, equating to a small treatment effect size (Cohen's d=0.2 at the optimal dose) (4, 5). However, this must be considered in the context of the widely reported side effects of atypical antipsychotics, which include extrapyramidal symptoms, sedation, gait disturbances, and falls. Many agents also lead to anticholinergic side effects, including delirium (4). Tardive dyskinesia with atypical antipsychotics appears to occur less frequently than with typical antipsychotics, but QTc prolongation has been reported as a significant problem associated with several atypical antipsychotics. A meta-analysis also identified a significant increase in respiratory and urinary tract infections as well as peripheral edema in people treated with risperidone, compared with placebo (4). These are likely to be class effects of atypical antipsychotics. It has also become clear that other, more serious adverse outcomes, such as stroke and related cerebrovascular events, accelerated cognitive decline, and death, are significantly increased in people with dementia who are prescribed antipsychotics, compared with people with dementia not treated with these agents. Deaths related to bronchopneumonia, thrombo-embolic events (including stroke and pulmonary embolism), and sudden cardiac arrhythmias are all significantly increased in people with dementia receiving antipsychotic treatment (6).