Pharmacologic Management of Agitation in Patients with Dementia
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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).
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.
KeywordsAggression 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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