Current methods for characterizing the behavioral and psychological symptoms of dementia (BPSD) consider the quality of the symptoms together with their frequency, intensity, and, in some instruments, their impact on the caregiver or the environment. Although there have been significant advances in our understanding of these symptoms and their treatment, a key parameter, environmental contingency, has been largely ignored in characterizing symptoms, planning treatments, and evaluating responses. In this brief review, I consider the feasibility and usefulness of subtyping aggressive and agitated symptoms in patients with dementia according to whether these behaviors occur spontaneously or in response to environmental factors.