Nonpharmacological intervention for agitation in dementia: A systematic review and meta-analysis (original) (raw)
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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.
Behavioral interventions for agitation in older adults with dementia: an evaluative review
International Psychogeriatrics, 2006
This review examined the application of behavioural principles to the management of agitation among older adults with dementia. Given that the review had methodological limitations and the quality of the included studies was considered to be poor, the authors' conclusions are appropriately cautious. Authors' objectives To review the empirical literature on behavioural interventions to reduce agitation in older adults with dementia. Searching PsycINFO was searched from 1970 to 200; no search terms were reported. The reference lists of related reviews and articles were screened for additional studies. Study selection Study designs of evaluations included in the review The authors did not state any inclusion criteria relating to study design. Specific interventions included in the review Studies evaluating interventions that were conceptualised behaviourally (with reference to principles such as reinforcement, stimulus control and punishment) and targeted at agitation characteristics were eligible for inclusion. A range of interventions were evaluated in the included studies. Participants included in the review Studies including participants aged 60 years or older (or with a mean age of at least 60 where ranges were not reported, or referred to as 'older' or 'elderly'), with a diagnosis of dementia, were eligible for inclusion in the review. Outcomes assessed in the review Studies reporting a form of behavioural measurement were eligible for inclusion. The target outcome behaviours included wandering, disruptive vocalisation, physical aggression and other agitated behaviours. A variety of definitions and measurement techniques were used. How were decisions on the relevance of primary studies made? Methods of synthesis How were the studies combined? The studies were combined in a narrative.
Treatment of agitation in dementia
New directions for mental health services, 1997
Agitation occurs commonly in patients with dementia. Before symptomatic pharmacotherapy is undertaken, it is imperative to perform a sequence of evaluations and interventions to establish whether simpler and safer, nonpharmacologic approaches will be beneficial. When psychotropic medications are used they should be used judiciously, in the lowest effective doses and for the shortest period of time necessary. Ineffective medications should be stopped, and even effective medications should be empirically tapered in most patients to learn whether treatment is still necessary. Antipsychotics probably show the greatest benefit for agitation associated with psychotic features; they have less demonstrated efficacy for agitation not associated with psychotic features. The side effects of typical agents are legion; data are pending regarding atypical agents. The available evidence regarding nonneuroleptic medications ranges from case reports to well-designed, double-blind, placebo-controlled...
Managing Agitation Using Nonpharmacological Interventions for Seniors With Dementia
American Journal of Alzheimer's Disease and Other Dementias, 2013
Approximately 36 million people have Alzheimer’s disease worldwide, and many experience behavioral issues such as agitation. The purpose of this study was to investigate the perceptions of long-term care (LTC) staff regarding the current use of nonpharmacological interventions (NPIs) for reducing agitation in seniors with dementia and to identify facilitators and barriers that guide NPI implementation. Qualitative methods were used to gather data from interviews and focus groups. A total of 44 staff from 5 LTC facilities participated. Findings showed that both medications and NPIs are used for the management of agitation. The use of NPIs was facilitated by consistency in staffing, and the ability of all the staff members to implement them. Common barriers to NPI use included the perceived lack of time, low staff-to-resident ratios, and the unpredictable and short-lasting effectiveness of NPIs. This study offers insight into perceived factors that influence implementation of NPIs and...
British journal of clinical pharmacology, 2018
To determine the most efficacious and acceptable treatments of agitation in dementia. MEDLINE, EMBASE, PsycINFO, CENTRAL and clinicaltrials.gov were searched up to 7 February 2017. Two independent reviewers selected randomized controlled trials (RCTs) of treatments to alleviate agitation in people with all-types dementia. Data were extracted using standardized forms and study quality was assessed using the revised Cochrane Risk of Bias Tool for RCTs. Data were pooled using meta-analysis. The primary outcome, efficacy, was 8-week response rates defined as a 50% reduction in baseline agitation score. The secondary outcome was treatment acceptability defined as treatment continuation for 8 weeks. Thirty-six RCTs comprising 5585 participants (30.9% male; mean ± standard deviation age, 81.8 ± 4.9 years) were included. Dextromethorphan/quinidine [odds ratio (OR) 3.04; 95% confidence interval (CI), 1.63-5.66], risperidone (OR 1.96; 95% CI, 1.49-2.59) and selective serotonin reuptake inhibi...
International Psychogeriatrics
ABSTRACTObjectives:More than 90% of individuals with Alzheimer’s disease (AD) experience behavioral and neuropsychiatric symptoms (NPS), such as agitation. However, little is known regarding the specific burden of agitation for Alzheimer’s patients.Design:A global systematic literature review was conducted in MEDLINE and Embase for studies of clinical, humanistic, and economic burden of agitation in AD/dementia published from 2006–2016. References of identified papers and related literature reviews were examined. Studies meeting predetermined inclusion criteria for burden of agitation/NPS were summarized.Results:Eighty papers met the inclusion criteria for burden of agitation in dementia. Wide ranges of agitation prevalence were reported, but few papers provided information on incidence. The association of agitation with AD severity was presented in multiple studies; a few suggested positive association of agitation with mortality.Conclusions:High prevalence of agitation is consiste...
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.