{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:45:12Z","timestamp":1791834312782,"version":"4.3.4"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Aging Hum Dev"],"abstract":"<jats:p>In contemporary dementia care, behavioral and psychological symptoms of dementia (BPSD) are often understood as expressions of the person's intentions or needs. This paper examines the limits of understanding BPSD as \u201cexpressions of intention\u201d in severe Alzheimer's disease. It argues that while desires may still be preserved, the formation and maintenance of beliefs\u2014an essential constituent of intentions in the standard desire\u2013belief model\u2014are likely to be severely compromised. As a result, many behavioral and perceptual symptoms closely related to basic activities of daily living cannot be adequately explained within an intention-based framework. As a complementary framework to existing dementia care theories, this paper proposes a reconceptualization of BPSD as arising from the interaction between embodied procedural memory and environmental affordances. Many BPSD are better understood not as expressions of intention, but as the outcome of situational and non-selective reactivation of fragments of relatively preserved procedural memory in response to the structure of the immediate environment. This reconceptualization extends the focus of care practice beyond the interpretation of the presumed meanings or intentions underlying BPSD and highlights the importance of modifying care environments in ways that appropriately support or constrain the reactivation of procedural memory.<\/jats:p>","DOI":"10.1177\/00914150261495486","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:42:46Z","timestamp":1791549766000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Behavioral and Psychological Symptoms of Dementia in Severe Alzheimer's Disease: From Intentional Explanation to an Ecological, Body\u2013Environment Framework"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7003-405X","authenticated-orcid":false,"given":"Ketu","family":"Ri","sequence":"first","affiliation":[{"name":"Hiroshima University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00308809"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.7414331"},{"key":"e_1_3_2_4_1","first-page":"8","article-title":"Theoretical frameworks for behavioral problems in dementia","volume":"1","author":"Cohen-Mansfield J.","year":"2000","unstructured":"Cohen-Mansfield J. 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(eds) (2013). Saishin. shinrigaku jiten [Latest dictionary of psychology]. Heibonsha."},{"key":"e_1_3_2_12_1","volume-title":"The ecological approach to visual perception","author":"Gibson J. J.","year":"1979","unstructured":"Gibson J. J. (1979). The ecological approach to visual perception. Houghton Mifflin."},{"key":"e_1_3_2_13_1","volume-title":"The IPA complete guides to behavioral and psychological symptoms of dementia (BPSD)","author":"International Psychogeriatric Association","year":"2010","unstructured":"International Psychogeriatric Association. (2010). The IPA complete guides to behavioral and psychological symptoms of dementia (BPSD). International Psychogeriatric Association."},{"key":"e_1_3_2_14_1","first-page":"1","article-title":"Eating behavior and environments of severe Alzheimer\u2019s disease patients with loss of language skills","volume":"8","author":"Ketu R.","year":"2022","unstructured":"Ketu R., Yokoi T., Miyoshi Y., Watanabe H., Fukuda T. (2022). Eating behavior and environments of severe Alzheimer\u2019s disease patients with loss of language skills. Gerontology & Geriatric Medicine, 8, 1\u20138. https:\/\/doi.org\/10.1177\/23337214221113848","journal-title":"Gerontology & Geriatric Medicine"},{"key":"e_1_3_2_15_1","volume-title":"Dementia reconsidered: The person comes first","author":"Kitwood T.","year":"1997","unstructured":"Kitwood T. (1997). Dementia reconsidered: The person comes first. Open University. Press."},{"key":"e_1_3_2_16_1","volume-title":"Disordered eating behaviors in patients with severe Alzheimer\u2019s disease: A preliminary study","author":"Li J.","unstructured":"Li J., Kaneko F., Saita K., Okamura H. (in press). Disordered eating behaviors in patients with severe Alzheimer\u2019s disease: A preliminary study. 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