Dementia is a growing global health challenge, and while research often focuses on cognitive decline and disease-modifying therapies, the role of informal caregivers remains underrecognized. The dyadic cohort study on neuropsychiatric symptoms (NPS) by Skoda et al.^{Reference Skoda, Miguel and Vincent1} investigates how NPS affect caregiver burden over time. Results revealed that caregiver burden was both prevalent and persistent, with nearly one-third reporting moderate-to-severe burden at baseline and follow-up. The study underscores the importance of addressing NPS to reduce caregiver distress and improve outcomes for both patients and caregivers. The need for an at-home-based patient-centered NPS care program, which is both more effective than medication and proven to be cost-effective in nursing homes, is essential.^{Reference Ballard, Corbett and Orrell2} With the increase in home-dwelling patients with dementia/mild behavioral impairment, new psychological and patient-centered approaches aimed specifically at home-dwelling patients, and their caregivers must be prioritized. The sex-specific patterns shown by Skoda et al.^{Reference Skoda, Miguel and Vincent1} further highlight the complexity of caregiving dynamics that must be addressed on an individual level.

The paper also presents a valuable point on the importance of the need for systematic assessment of NPS in clinical practice, with care taken for the differences between dementia diagnosis.^{Reference Vik-Mo, Giil, Ballard and Aarsland3} While cognitive testing is routine, behavioral and psychological symptoms are often under-monitored.

A 12-year follow-up study showed a highly individual course of NPS, with most presenting as a single episode or relapsing; a stable course was less common, especially in Lewy body dementia.^{Reference Vik-Mo, Giil, Borda, Ballard and Aarsland4} These findings demonstrate the importance of an individualized approach in dementia care, and that short-term interventions with coping strategies have good clinical potential. Recent dyadic research echoes these findings, showing depression, anxiety, disinhibition, and sleep disorders as predictors of prolonged high burden and as more often stable symptoms.^{Reference Vik-Mo, Giil, Ballard and Aarsland3,Reference Vik-Mo, Giil, Borda, Ballard and Aarsland4}

Further work on clinical interventions to target caregivers is needed as a complement to patient-centered approaches to mitigate caregiver distress and ultimately improve the quality of life for both caregivers and individuals living with dementia from diagnosis to palliative care.^{Reference OHara-Veintimilla, Borda, Olivera, Sánchez-Pérez, Vik-Mo and Hui5}