Treatment of agitation in dementia (original) (raw)

Managing agitation in Alzheimer's disease and related disorders

Background: Alzheimer disease (AD) will affect increasing numbers of subjects as the population ages. Patients with AD and related disorders often develop agitation during the moderate to severe stages of their dementia. Agitation is often the reason that dementia patients need to be institutionalized. This review will address the natural history of agitation in AD, dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD). It will also discuss the use of antidepressants, antipsychotic agents and anticonvulsant drugs in preventing and treating agitation in dementia patients.

Alternative pharmacological treatment options for agitation in Alzheimer’s disease

Geriatric Care, 2015

In patients with dementia and Alzheimer’s disease (AD), treatment of neuropsychiatric symptoms (NPS) is a major concern in the management of these devastating diseases. Among NPS in AD, agitation and aggression are common with earlier institutionalization, increased morbidity and mortality, and greater caregiver burden. Pharmacological treatments for AD-related agitation, specifically off-label use of atypical antipsychotics, showed only modest improvements, with increased side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred firstline option. However, when such treatments fail, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for agitation/aggression in AD and dementia. Unfortunately, progresses have been slow, with a small number of methodologically heterogeneous randomized controlled trials (RCTs), with disappointing results. However, evidence...

Progresses in treating agitation: a major clinical challenge in Alzheimer's disease

Expert opinion on pharmacotherapy, 2015

Treatment of neuropsychiatric symptoms (NPS) represents a major clinical challenge in Alzheimer's disease (AD). Agitation and aggression are frequently seen during institutionalization and increase patient morbidity and mortality and caregiver burden. Off-label use of atypical antipsychotics for treating agitation in AD showed only modest clinical benefits, with high side-effect burden and risk of mortality. Non-pharmacological treatment approaches have become the preferred first-line option. When such treatment fails, pharmacological options are often used. Therefore, there is an urgent need to identify effective and safe pharmacological treatments for efficiently treating agitation and aggression in AD and dementia. Areas covered: Emerging evidence on the neurobiological substrates of agitation in AD has led to several recent clinical trials of repositioned and novel therapeutics for these NPS in dementia as an alternative to antipsychotics. We operated a comprehensive literat...

The Urgent and Unmet Need for Safe and Effective Treatment of Agitation

Agitation may occur in many settings: upon emergence from anesthesia, in the context of certain mental illnesses, secondary to brain injury or substance abuse, as a side effect of medication, and with certain forms of cognitive impairment. Agitation occurs frequently in patients with dementia, including but not limited to Alzheimer’s disease. This neuropsychiatric symptom is likely related to dysfunctional neurotransmissions, but the exact mechanisms remain unknown. There is no FDA-approved treatment for agitation but several agents are used off-label to help manage agitation, which can be a chronic and troublesome condition in patients with dementia. Antipsychotics, antidepressants, opioid analgesia, cannabinoids, antiepileptic agents, dextromethorphan, scyllo-inositol, brexipiprazole, and prazosin are discussed as possible treatments in the literature. The effectiveness of many pharmacological interventions for agitation can be equivocal and safety issues are of concern. Nonpharmacological interventions, such as music therapy, aromatherapy, and animal-assisted therapy, have reported modest success but may be difficult to implement emergency departments as well as in some institutionalized settings. As the geriatric population in developed nations increases, agitation secondary to various forms of dementia will likely increase as well. Agitation can pose risks to patients and their caregivers and there is an urgent unmet medical need to find safe, effective treatments.

Pharmacologic Treatment of Agitation and Apathy in Dementia

2007

Pharmacologic Treatment of Agitation and Apathy in Dementia Shailaja Shah, MD, Clinical Assistant Professor, Assistant Director Geriatric Psychiatry Fellowship, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA. Gautam Rohatgi, DO, Geriatric Psychiatry Fellow, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA. Daniela Ganescu, MD, Geriatric Psychiatry Fellow, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA. DEMENTIA PHARMACOTHERAPY

Nonpharmacological Management of Agitated Behaviours Associated with Dementia

Abstract Strategies such as simulated presence therapy, pet therapy, light therapy, validation therapy, music, massage, therapeutic touch, aromatherapy, and multisensory stimulation have shown promising results in decreasing physical aggression, physical nonaggression, verbal aggression, and verbal nonaggression in older adults with dementia. Further research is needed to identify which strategies are most effective in managing symptoms of agitation associated with the different types of dementia and at different levels of cognitive impairment.

Pharmacological Treatment of Psychosis and Agitation in Elderly Patients with Dementia

Drugs & Aging, 2002

A number of studies, using different research designs and assessment instruments, have been conducted to elucidate the differential effects of drug treatments for psychosis, agitation and aggression in elderly patients with dementia. We have reviewed literature published from 1960 to 2000 on this topic; 48 studies that met our selection criteria were identified from Medline and Science Citation Index. Antipsychotic medication was generally effective for the treatment of psychosis and agitation in elderly patients with dementia. In double-blind, placebocontrolled trials in this population, mean improvement rates were 61% with antipsychotics and 35% with placebo. Atypical antipsychotics appeared promising, but the number of well-designed studies has been small so far. Methodological limitations of the studies reviewed are discussed; future trials should ensure adequate sample size and duration and involve direct comparisons of individual medications.

Nonpharmacological intervention for agitation in dementia: A systematic review and meta-analysis

Aging & Mental Health, 2009

This well-conducted review concluded that sensory interventions were the only type of non-pharmacological intervention in older adults with dementia to show beneficial effects in reducing agitation. These conclusions are likely to be reliable but, as the authors acknowledged, should be interpreted with some caution given the small sample sizes and variability in the interventions. Authors' objectives To determine the effectiveness of non-pharmacological interventions for agitation in older adults with dementia. Searching MEDLINE, CINAHL, PsycINFO, AgeLine, EBM Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), ACP Journal Club and ISI index were searched from inception to June 2004. Search terms were reported. References of review articles and potentially relevant studies were screened. The review was restricted to published studies in English or Korean.