Patients with dementia frequently experience comorbid behavioral and psychiatric symptoms, also known as neuropsychiatric symptoms of dementia. Neuropsychiatric symptoms are harmful to both patients and their caregivers, and contribute to the high healthcare costs associated with Alzheimer’s dementia. Since the discovery of neuroleptic medications in the 1950s, antipsychotic medications have been the preferred drug option for the treatment of behavioral and psychiatric symptoms of dementia. Despite their frequent use in the past, there is limited evidence to support the efficacy of first-generation antipsychotics in this population. Second-generation antipsychotics may be modestly helpful for reducing global neuropsychiatric symptoms, psychosis, and agitation/aggression in demented older adults. However, second-generation antipsychotics are associated with potentially serious adverse reactions in elderly adults, which may undermine the potential benefits. In clinical practice, second-generation antipsychotics are prescribed for demented patients with distressing or dangerous behavioral disturbances that fail to respond adequately to nonpharmacological approaches. The decision to utilize an antipsychotic requires thoughtful consideration of the potential risks and benefits for the individual patient.