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Agitation and Irritability in Alzheimer’s Disease: Evidenced-Based Treatments and the Black-Box Warning

Current Psychiatry Reports volume 18, Article number: 3 (2016) Cite this article

Abstract

More than five million Americans suffer from Alzheimer’s disease (AD), and this number is expected to triple by 2050. While impairments in cognition, particularly memory, are typically the defining features of the clinical syndrome, behavioral symptoms are extremely common, affecting up to 90 % of patients. Behavioral symptoms in AD can be difficult to manage and may require a combination of non-pharmacological and pharmacological approaches. The latter is complicated by FDA “black-box warnings” for the medication classes most often used to target these symptoms, and currently there are initiatives in place to limit their use. In this review, we describe common behavioral symptoms of AD—with a particular focus on the challenging symptoms of “agitation” and “irritability”—and discuss evidence-based approaches to their management. Ultimately, multidimensional approaches must be tailored to the patient and their environment, though evidence-based practices should define the treatment of agitation and irritability in AD.

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Authors and Affiliations

  1. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Aaron M. Koenig

  2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Aaron M. Koenig

  3. MassGeneral Institute for Neurodegenerative Disease, Boston, MA, USA

    Steven E. Arnold

  4. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    Steven E. Arnold

  5. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

    Joel E. Streim

  6. Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA

    Joel E. Streim

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  1. Aaron M. Koenig
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Correspondence to Aaron M. Koenig.

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This work was supported, in part, by National Institutes of Health grant T32 MH1711929 (AMK).

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This article is part of the Topical Collection on Geriatric Disorders

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Koenig, A.M., Arnold, S.E. & Streim, J.E. Agitation and Irritability in Alzheimer’s Disease: Evidenced-Based Treatments and the Black-Box Warning. Curr Psychiatry Rep 18, 3 (2016). https://doi.org/10.1007/s11920-015-0640-7

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