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Background: The burden of behavioral and psychiatric symptoms in dementia (BPSD) has not been characterized in Saudi patients with Alzheimer disease (AD). Moreover, the Saudi version of the Neuropsychiatric Inventory (SNPI) has not been validated., Objectives: The purpose of this study was to validate the SNPI and describe frequency and determinants of BPSD in Saudi AD patients., Methods: The SNPI and BEHAVE-AD instruments were administered to community-dwelling Saudi AD patients and their caregivers., Results: The sample size was 192. The first 59 constituted the validation cohort. Cronbach alpha of the SNPI and BEHAVE-AD were 0.91 and 0.79, respectively. There were significant correlations between: (1) the total SNPI and BEHAVE-AD scores ( r =0.84, P <0.001); (2) analogous SNPI and BEHAVE-AD symptom subscores ( P <0.05); (3) SNPI and BEHAVE-AD caregiver distress ( F =22.6, P <0.001). Inter-rater reliability of the SNPI was excellent (kappa=0.74). Ninety percent of patients experienced 4 SNPI symptoms or more. Patients with stroke and prior psychiatric history were most likely to experience BPSDs. The most common symptom was apathy (82%). Caregiver distress was determined by the total NPI score and impulsiveness subscale score., Conclusions: The SNPI is valid and reliable for assessing BPSD in Saudi AD patients. Longitudinal studies of BPSDs in Saudi specialized dementia clinics are needed., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)