This chapter focuses on giving an overview of the current care of dementia patients with very severe to extreme behavioural and psychological symptoms (BPSD), particularly aggressive behaviour. We start with an authentic case which will be the heart of this chapter. We also discuss the pharmacological treatment that is often still used, even though side effects are common and may make the symptoms of BPSD even more problematic. The chapter continues discussing person-centred methods in relation to dementia patients with very severe to extreme BPSD. We expected to find answers in the literature on how to manage severe or extreme BPSD and aggression in a person-centred way, but this proved to be difficult. As a conclusion, we offer a discussion on how future care might improve for this group of patients.