Psychosis is a common and distressing symptom in people with
Alzheimer disease, and few safe and effective treatments are available. However, new approaches to symptom assessment and treatment are beginning to drive the field forward. New nosological perspectives have been provided by incorporating the emergence of psychotic symptoms in older adults - even in advance of
dementia - into epidemiological and neurobiological frameworks as well as into diagnostic and research criteria such as the International Psychogeriatric Association criteria for
psychosis in
neurocognitive disorders, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) research criteria for
psychosis in
neurodegenerative disease, and the ISTAART criteria for mild behavioural impairment. Here, we highlight the latest findings in genomics, neuroimaging and neurobiology that are informing approaches to drug discovery and repurposing. Current pharmacological and non-pharmacological treatment options are discussed, with a focus on safety and
precision medicine. We also explore trial data for
pimavanserin, a novel agent that shows promise for the treatment of
psychosis in people with
dementia, and discuss existing agents that might be useful but need further exploration such as
escitalopram,
lithium,
cholinesterase inhibitors and
vitamin D. Although the assessment and management of
psychosis in people with
dementia remain challenging, new opportunities are providing direction and hope to the field.