Agitation in predementia and
dementia
Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...
is distressed
affect that leads to poor
moods and often
aggression
Aggression is behavior aimed at opposing or attacking something or someone. Though often done with the intent to cause harm, some might channel it into creative and practical outlets. It may occur either reactively or without provocation. In h ...
toward other people, such as family members and other
caregiver
A caregiver, carer or support worker is a paid or unpaid person who helps an individual with activities of daily living. Caregivers who are members of a care recipient's family or social network, who may have specific professional training, are o ...
s. Agitation is often part of dementia and often precedes the diagnosis of common age-related disorders of cognition such as
Alzheimer's disease
Alzheimer's disease (AD) is a neurodegenerative disease and the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems wit ...
(AD). More than 80% of people who develop AD eventually become agitated or aggressive. Agitation in dementia overlaps with
psychomotor agitation
Psychomotor agitation is a symptom in various disorders and health conditions. It is characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress and is always an indicative for ...
but is not always equal to it, depending on whose definition is used. Although some authorities consider them synonymous,
psychomotor agitation by definition ("-motor") involves maladaptive movements, whereas agitation in predementia and dementia often involves distress, fear, and aggression even when repetitive purposeless movements (such as pacing) are absent. The synonymy viewpoint views the whole topic as a single spectrum in which repetitive purposeless movements may arise or not, or recede, at various times.
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Evaluation
It is important to rule out infection and other environmental causes of agitation, such as disease or other bodily discomfort, before initiating any intervention. If no such explanation is found, it is important to support caregivers and educate them about simple strategies such as distraction that may delay the transfer to institutional care (which is often triggered by the onset of agitation).
Treatment
On May 11, 2023, the FDA approved
brexpiprazole (brand name – Rexulti) as a prescription medication for treatment of agitation in dementia.
Medical treatment may begin with a
cholinesterase inhibitor
Cholinesterase inhibitors (ChEIs), also known as anti-cholinesterase, are chemicals that prevent the breakdown of the neurotransmitter acetylcholine or butyrylcholine by cholinesterase. This increases the amount of the acetylcholine or butyryl ...
, which appears safer than other alternatives although evidence for its efficacy is mixed. If this does not improve the symptoms,
atypical antipsychotic
The atypical antipsychotics (AAP), also known as second generation antipsychotics (SGAs) and serotonin–dopamine antagonists (SDAs), are a group of antipsychotic drugs (antipsychotic drugs in general are also known as tranquilizers and neurol ...
s may offer an alternative, although they are effective against agitation only in the short-term while posing a well-documented risk of cerebrovascular events (e.g.
stroke
Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
). Other possible interventions, such as traditional antipsychotics or antidepressants, are less well studied for this condition.
[{{cite journal , author= James M. Ellison, title= Agitation in dementia: Update and prospectus , journal=Psychiatric Times, volume=25 , issue=2, date= February 1, 2008 , url=http://www.psychiatrictimes.com/alzheimer-dementia/article/10168/1147716]
References
Dementia