Abstract: Objective To evaluate the efficacy of quetiapine combined with piracetam in the treatment of elderly patients with dementia and behavioral and psychological symptoms of dementia (BPSD), and its impact on cognitive function. Methods A retrospective analysis was conducted on 98 elderly patients with dementia and BPSD admitted to Zhoushan Second People,s Hospital from January 2021 to February 2024. Patients were divided into two groups according to different treatment regimens: the control group (49 cases) received quetiapine alone, while the observation group (49 cases) received quetiapine combined with piracetam. After treatment, clinical efficacy, serum prolactin and lipid levels, Brief Psychiatric Rating Scale (BPRS) scores, Mini-Mental State Examination (MMSE) scores, Social Disability Screening Schedule (SDSS) scores, and the incidence of adverse reactions were compared between the two groups. Results The overall clinical response rate in the observation group was significantly higher than that in the control group (P < 0.05). After treatment, the observation group showed significantly lower BPRS and SDSS scores and serum prolactin levels, as well as significantly higher MMSE scores and high-density lipoprotein cholesterol (HDL-C) levels compared to the control group (P < 0.05). No statistically significant differences were observed between the two groups in the levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or the overall incidence of adverse reactions after treatment (P > 0.05). Conclusion The combination of quetiapine and piracetam demonstrates notable therapeutic efficacy in elderly patients with dementia and BPSD, with improvements in cognitive and social functioning and a minimal impact on prolactin levels.