Behavioral and psychological symptoms of dementia (BPSD) encompass a spectrum of noncognitive disturbances including agitation, aggression, psychosis, depression, and anxiety. These symptoms may affect up to 90% of individuals with dementia and can significantly impair patient quality of life and increase caregiver burden and healthcare costs. The pathophysiology of BPSD involves neurotransmitter dysregulation, structural brain changes, environmental stressors, and psychological predispositions. Non-pharmacological interventions, such as person-centered care, environmental modifications, and therapeutic activities, are considered first-line strategies of management due to their safety and efficacy. Pharmacological treatments are reserved for severe cases and include antipsychotics, antidepressants, cholinesterase inhibitors, and emerging agents like brexpiprazole, AXS-05, and cannabinoids. While some agents show promise, many remain off-label and carry risks such as sedation, cardiovascular events, and increased mortality. Caregiver education and support are essential components of effective BPSD management. Future research priorities include biomarker identification, development of safer pharmacotherapies, and evaluation of long-term outcomes of psychosocial interventions. A comprehensive, individualized approach integrating both non-pharmacological and pharmacological strategies is critical to improving dementia care.