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Pharmacologic Management of Agitation in Patients with Dementia

  • Palliative Care (D Wu, Section Editor)
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Abstract

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.

Summary

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.

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Authors and Affiliations

  1. Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle, WA, USA

    Cara L. McDermott

  2. Geriatrics and Extended Care Service, VA Puget Sound Health Care System, S-182-GEC, 1660 S. Columbian Way, Seattle, WA, 98108, USA

    David A. Gruenewald

  3. Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA

    David A. Gruenewald

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  1. Cara L. McDermott
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McDermott, C.L., Gruenewald, D.A. Pharmacologic Management of Agitation in Patients with Dementia. Curr Geri Rep 8, 1–11 (2019). https://doi.org/10.1007/s13670-019-0269-1

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