Infrequently, psychiatric symptoms may be the only manifestation of brain tumors. They may present with mood symptoms, psychosis, memory problems, personality changes, anxiety, or anorexia. Symptoms may be misleading, complicating the clinical picture. A comprehensive review of the literature was conducted regarding reports of brain tumors and psychiatric symptoms from 1956-2014. Search engines used include PubMed, Ovid, Psych Info, MEDLINE, and MedScape. Search terms included psychiatric manifestations/symptoms, brain tumors/neoplasms. Our literature search yielded case reports, case studies, and case series. There are no double blind studies except for post-diagnosis/-surgery studies. Early diagnosis is critical for improved quality of life. Symptoms that suggest work-up with neuroimaging include: new-onset psychosis, mood/memory symptoms, occurrence of new or atypical symptoms, personality changes, and anorexia without body dysmorphic symptoms. This article reviews the existing literature regarding the diagnosis and management of this clinically complex condition.

Core tip: Dementia may present with neuropsychiatric symptoms that may require pharmacological interventions. Medications used for the behavioral symptoms associ ated with dementia are not Food and Drug Administration approved and hence are being used offlabel in the United States. The decision to start medications is based on a judi cious consideration of risks and benefits. The choice of the agent should be guided by a thorough understanding of its pharmacologic properties and safety profiles, concomitant medications, and concurrent medical conditions. This article reviews the current evidence for psychotropic medications and presents recommendations with an algorithm for the treatment of neuropsychiatric symptoms associated with dementia. INTRODUCTIONDementia is a clinical syndrome which includes a heterogeneous group of disorders that lead to cognitive decline in the absence of delirium [1] . Although the cognitive decline is a core feature of dementia, this may be associated with a variety of neuropsychiatric symptoms [1] . These symptoms are as follows: (1) affective and motivational symptoms; (2) perceptual disturbances; (3) delusions; (4) disturbances of basic drives; and (5) disinhibition and inappropriate behaviors [1] . A five-year study on the AbstractDementia is a clinical syndrome with features of neurocognitive decline. Subtypes of dementia include Alzheimer's, frontotemporal, Parkinson's, Lewy body disease, and vascular type. Dementia is associated with a variety of neuropsychiatric symptoms that may include agitation, psychosis, depression, and apathy. These symptoms can lead to dangerousness to self or others and are the main source for caregiver burnout. Treatment of these symptoms consists of nonpharmacological and pharmacological interventions. However, there are no Food and Drug Administrationapproved medications for the treatment of behavioral and psychological symptoms of dementia. Pharmacological interventions are used offlabel. This article reviews the current evidence supporting or negating the use of psychotropic medications along with safety concerns, monitoring, regulations, and recommendations. REVIEWSubmit a

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