Pain in the elderly, especially those with dementia, is often undertreated and misdiagnosed by health care professionals in the long-term care setting. Communication barriers in patients with cognitive impairment force pain assessment to rely heavily on subjective interpretation of behavioral factors due to the inability of patients to self-report pain symptoms. It is important for clinicians to develop a standard method of identifying and assessing signs of pain in patients with dementia in order to appropriately treat those experiencing discomfort. Patients with dementia who present with a sudden onset of behavioral changes should receive a comprehensive evaluation that includes a patient questionnaire, standardized pain assessment scale, an observational method of assessment and family member or caregiver interviewing to assess if these changes in behavior could be a result of undiagnosed pain. Proper differential diagnosis of symptom presentation is the only way to ensure that cognitively impaired patients receive the correct diagnosis and treatment to resolve the underlying cause of symptomatology.