Cognitive impairment is a defining feature of dementia, although noncognitive symptoms
seem to be more closely associated with deteriorating quality of life and burden of
care.
1
Among these, agitation can be particularly distressing, and potentially harmful,
to people with dementia and their carers. Agitation is a descriptive term that encompasses
a range of behaviors such as wandering, repetitive, purposeless or socially inappropriate
activity, and verbal or physically aggressive or destructive actions toward self,
others or the surrounding environment. The management of such behaviors is often challenging,
and existing clinical guidelines generally counsel against the use of pharmacological
interventions to treat agitation in people with dementia.
2
,3
When the risk of harm to self or to others is high, treatment with antipsychotic
medications may be considered, although their widespread use is limited by concerns
about serious adverse events.
4
,5
The potential clinical benefit associated with the use of other psychotropic agents
for the management of agitation is even less compelling,
6
so that the need to find an intervention that is both efficacious and well tolerated
remains an urgent clinical priority.To read this article in full you will need to make a payment
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References
- Determining the predictors of change in quality of life self-ratings and carer-ratings for community-dwelling people with Alzheimer disease.Alzheimer Dis Assoc Disord. 2013; 27: 363-371
- Clinical Practice Guidelines and Principles of Care for People with Dementia.National Health and Medical Research Council, Sydney2016
- Dementia: Assessment, Management and Support for People Living with Dementia and Their Carers.National Institute for Health and Care Excellence, United Kingdom2018
- The American Psychiatric Association Practice Guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia.Am J Psychiatry. 2016; 173: 543-546
- Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses.Ther Adv Chronic Dis. 2016; 7: 229-245
- Pharmacological treatments for alleviating agitation in dementia: asystematic review and network meta-analysis.Br J Clin Pharmacol. 2018; 84: 1445-1456
- Overview of short- and long-term tolerability and safety of brexpiprazole in patients with schizophrenia.Schizophr Res. 2016; 174: 93-98
- Efficacy and safety of brexpiprazole for the treatment of agitation in Alzheimer's dementia: two 12-week, randomized, double-blind, placebo-controlled trials.Am J Geriatr Psychiatry. 2020; 28: 383-400
- Assessment of reported comparative effectiveness and safety of atypical antipsychotics in the treatment of behavioral and psychological symptoms of dementia: a network meta-analysis.JAMA Netw Open. 2019; 2e190828
- Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial.JAMA. 2014; 311: 682-691
Article info
Publication history
Published online: November 15, 2019
Accepted:
November 11,
2019
Received:
November 11,
2019
Identification
Copyright
© 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
