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In regards to summarizing the literature on the challenges facing the management of dementia, two major thrusts of research exist: how best to categorize patients and how best to treat them. Aud (2001) found that by breaking down specific categories of de-identified resident data including behavioral symptoms, activity participation, medication use, health conditions, pain, falls, emergency room visits, and hospitalizations help result in better predictive patient outcomes. In a similar vein, Zimmerman (2010) suggested that the physical and psychosocial care environment, such as the characteristics of the nursing staff, influence the well-being of people with dementia, more than any other modifiable factor. In fact, the importance of the quality of nursing care staff has been echoed elsewhere, notably in Care (2010). This work examined the development of an educational tool which facilitates learning and professional development around the issues of person and relationship-centered dementia care and dramatically improved quality of care in dementia patients. From a different perspective, Gould (2010) there is a significant but small benefit in developing scripted training programs for staff in learning how best to manage dementia patients. In short, a general synthesis of this first area of research strongly promotes the understanding that quality nursing staff and a supportive psychosocial environment are critical to patient outcomes.

Regarding the best treatment of dementia, there is much less consensus. Defilipi (2000) found that typical antipsychotics have a modest effect on psychosis and behavioral symptoms, and preliminary studies suggest that atypical agents are effective. Yet, Steinmetzd (2010) argues that the patients considered difficult often are not in need of medical intervention and are not the ones experiencing major medical problems. Instead, they are the people who behave rudely and want a secondary gain. Patients with multiple non-specific complaints and those with psychosomatic problems are often the most challenging to manage long-term. Lastly, Williams (2009) argued that when discussing a treatment plan the probability of receptiveness to care varied significantly with communication acumen of the practitioner. An increased probability of receptiveness to care occurred with elderspeak compared with normal speak. Individuals with dementia slowly progress from forgetfulness to a stage of confusion which brings them to a new, different, initially strange and threatening mode of being. The patient's want and desire to keep up on their appearances and previous life is abandoned and their memory dissolves progressively more. They tend to live more in their own, dreamlike "world" which mingles the present and past together and the rules and structures of the "old world" looses its importance. During an increase of loss of memory, tends to derive limited vocabulary and verbal communication (Kuske, 2009).

In conclusion, the general literature around dealing with problematic patients and dementia is varied but clear trends emerge. The importance of a positive psychosocial environment is critical along with effective interventions cannot be understand from the studies examined in producing positive patient outcomes. Further research in the field in necessary to elucidate how best to intervene and what environmental factors are most significant.