Objectives <p>The aim of the present study was to describe the association between behavioral and psychological symptoms and psychotropic drug use among older Swedish nursing home residents with cognitive impairment.</p> Methods <p>Data was collected from a questionnaire survey which was sent out between 4 and 12 February 2019 within the Swedish National Inventory of Care and Health in Residential Aged Care (SWENIS) II. Sixty municipalities in Sweden were randomly selected and invited. Of these, 49 municipalities accepted the invitation. Six withdrew resulting in 43 participating municipalities and 187 nursing homes. The final study population comprised 1,541 participants, 65 years or older, with cognitive impairment. The Swedish Prescribed drug register was utilized to identify psychotropic drug use. Backward eliminating binary logistic regression analyses were conducted.</p> Results <p>At least one psychotropic drug was used of 80.8% of the study population, 20.5% used at least one antipsychotic drug, 32.0% used anxiolytic drugs, 21.3% used hypnotic and sedatives, 58.4% used antidepressants and 32.1% of the residents used antidementia drugs. Among residents with mild cognitive impairment, anxiolytics were significantly associated with anxiety. Also, anxiolytics and hypnotics and sedatives were significantly associated with sleep and nighttime behavior disorders. Antidepressants were significantly associated with depression/dysphoria. The same pattern was found among residents with moderate cognitive impairment. However, anxiolytics were also significantly associated with worsening depression/dysphoria. Hypnotics and sedatives were also associated with anxiety and hallucinations. Moreover, antipsychotic drug use was significantly associated with agitation/aggression and anxiety. Among residents with severe cognitive impairment, antipsychotics, anxiolytics and hypnotics and sedatives were significantly associated with aberrant motor behavior. Anxiolytics were also significantly associated with anxiety and apathy/indifference, and hypnotics and sedatives were significantly associated with agitation/aggression and depression/dysphoria.</p> Conclusions <p>Psychotropic drug use is remarkably high among Swedish nursing home residents but the prevalence of antidementia drugs is somewhat low. Associations found, call for further studies examining the treatment of behavioral and psychological symptoms (BPS) in this vulnerable group of people.</p>