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Treatment Options for Agitation in Dementia

  • Dementia (J Pillai, Section Editor)
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Abstract

Purpose of review

The goal of the current review is to provide an update on the management of agitation in persons with dementia with a focus on pharmacological management of persons with Alzheimer’s disease.

Recent findings

As consistently effective and safe pharmacologic interventions are still lacking, identifying and addressing medical and environmental precipitants remain a priority. Acetylcholinesterase inhibitors and memantine should be initiated to enhance cognition, and if present, management of insomnia or sundowning with trazodone is indicated. If agitation persists, treatment with citalopram can be initiated with attention paid to potential prolongation of the QT interval. Treatment with low doses of atypical antipsychotics such as risperidone or quetiapine can be effective after appropriate consideration of and disclosure of potential adverse effects.

Summary

In light of the lack of consistently effective treatments for agitation in dementia, there have been renewed efforts to define the condition and improve the design of trials of medications to treat it. Considering the heterogeneity of patients and their comorbidities as well as the specific nature of their “agitation”, there is no “one-size fits all” approach to agitation in AD. However, many options exist that can be prudently pursued for this common problem in this delicate population.

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Acknowledgments

Preparation of this manuscript was supported by NIH P50 AG-005142.

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Authors and Affiliations

  1. Helene and Lou Galen Professor of Clinical Neurology, Department of Neurology, Center for Health Professions, Keck School of Medicine at USC, 1540 Alcazar Street, Suite 209F, Los Angeles, CA, 90033, USA

    John M. Ringman MD, MS

  2. Keck School of Medicine of USC, 1540 Alcazar St, #216, Los Angeles, CA, 90089, USA

    Lon Schneider MD, MS

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John M. Ringman declares no potential conflict of interest. Lon Schneider reports grants from NIH and grants from the State of California, during the conduct of the study, and grants from NIH, grants and personal fees from Eli Lilly, grants and other from Lundbeck, grants and personal fees from Roche/Genentech, personal fees from Merck, personal fees from AC Immune, personal fees from Avraham, personal fees from Takeda, personal fees from Cognition, grants from Novartis, grants from Biogen, personal fees and other from vTv, personal fees and other from Allergan, personal fees from Neurim, personal fees from Axovant, personal fees from Neuronix, personal fees from Eisai, and personal fees from Toyama, outside the submitted work.

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Ringman, J.M., Schneider, L. Treatment Options for Agitation in Dementia. Curr Treat Options Neurol 21, 30 (2019). https://doi.org/10.1007/s11940-019-0572-3

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