OBJECTIVES:   The key objective of this study was to review evidence regarding off-label use of atypical antipsychotics for treating behavioral problems in patients with Dementia of Alzheimer's type. A secondary objective was to examine patterns of atypical antipsychotic drug use in this population with respect to the extent and type of neurological and mental health co morbidities. METHODS:  National Nursing Home Survey (NNHS, 2004), a nationally representative survey of US nursing home residents, was utilized to identify residents with senile dementia of the Alzheimer type (SDAT). Variables that represented attention to dementia care and special services for behavioral problems were analyzed to understand treatment patterns and associated medication use. Relationships between atypical antipsychotic drug use and the type and extent of neurological and mental health co morbidities were discerned using appropriate bivariate and multivariate statistics. RESULTS:   The un-weighted resident sample yielded 1958 (14.5%) cases of SDAT, with more women (77.2%) than men. More than half of the residents diagnosed with the condition belonged to the age group 70 years or older. While 166 (8.5%) residents participated in a special program for dementia, about 238 (12.15%) of the residents received special services for behavioral problems. 618 (31%) residents were prescribed at least one of the top three atypical anti-psychotic medications. Prevalence of neurological and mental health co morbidities varied from 37% (Depression), 7.8% (Psychosis), 3.9% (agitation) to 1.8% (Schizophrenia). CONCLUSIONS:   Prevalence of SDAT increases with age. The use of atypical antipsychotics is high in this segment of the nursing home population and a substantial portion of prescribing maybe off-label, especially when used for the treatment of behavioral problems. Existence of co morbidities may be a contributing factor to the increased prescribing of atypicals in nursing homes.