Agitation in dementia: Are drugs the best treatment?

In a paper that is now published in the journal International Psychogeriatrics, experts from several research institutions — including the University of Michigan in Ann Arbor, and Johns Hopkins University in Baltimore, MD — express their consensus on the best approaches to manage dementia-related behavioral and psychological symptoms.

More specifically, they speak of how to address states of agitation and psychosis in people with Alzheimer’s disease.

This paper — which is based on the evidence presented by dementia experts across the globe — ranks the best methods of addressing agitation in Alzheimer’s, and nondrug-based approaches come first.

This research advocates a significant shift from current practice, recommending that nonpharmacological treatments are the first-line approach for agitation in dementia.”

Person-centered care to be prioritized

In the new study, the first four treatments that the researchers advise healthcare professionals and other caregivers to prioritize are all nonpharmacological, focusing on behavioral approaches instead.

They also encourage providing appropriate education to caregivers and adapting the environment that people with Alzheimer’s inhabit to suit their needs as closely as possible.

According to the experts’ evidence, a person-centered approach to care and providing an activity program that fits the individuals’ needs are, more often than not, preferable to administering drugs when it comes to addressing agitation.

As for the pharmacological treatments, the highest-ranking drug for behavioral symptoms was the antidepressant citalopram, and even this only ranked sixth on the experts’ list. Medication for pain management also ranked higher than other drugs.

Of the antipsychotic drugs currently prescribed, the specialists consensually recommended only risperidone, which came in seventh on the list of treatments and approaches.

“Aside from risperidone at number [seven] in the list, none of the other atypical antipsychotic drugs were recommended,” notes Dr. Kales.

“This is a very welcome change,” she emphasizes, “given the known harms associated with these treatments.”

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