Pharmacologic Management of Agitation in Patients with Dementia

  • Cara L. McDermott
  • David A. GruenewaldEmail author
Palliative Care (D Wu, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Palliative Care


Purpose of Review

Agitation is common among older adults with dementia; its origin may be multi-factorial, and it is often difficult to treat. In this paper, we summarize current knowledge and offer considerations on pharmacologic management of behavioral and psychological symptoms of dementia (BPSD).

Recent Findings

We reviewed human studies published from 2013 to 2018 evaluating pharmacologic management of BPSD manifestations including depressive symptoms, mania, psychosis, and other BPSD, as well as severe agitation without determination of underlying cause. After non-pharmacological management is exhausted, the choice of pharmacological options depends on patient comorbidities, specific BPSD presentation, and patient tolerance of medications.


Depending on manifestations of BPSD, low- to moderate-quality evidence supports the use of anti-depressants, anti-psychotics, or anti-epileptics in conjunction with cholinesterase inhibitors. The current evidence base needs to be augmented with future research that focuses on real-world medication use alongside head-to-head evaluation of medication effectiveness rather than comparison to placebo.


Aggression Agitation Alzheimer disease Behavior and psychological symptoms Dementia Medication 


Compliance with Ethical Standards

Conflict of Interest

Cara McDermott and David Gruenewald declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


The contents of this article do not represent the views of the US Department of Veterans Affairs or the US Government.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Cambia Palliative Care Center of ExcellenceUniversity of Washington School of MedicineSeattleUSA
  2. 2.Geriatrics and Extended Care ServiceVA Puget Sound Health Care System, S-182-GECSeattleUSA
  3. 3.Division of Gerontology and Geriatric Medicine, Department of MedicineUniversity of Washington School of MedicineSeattleUSA

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