John M Ringman1, Lon Schneider2. 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.ringman@med.usc.edu. 2. Keck School of Medicine of USC, 1540 Alcazar St, #216, Los Angeles, CA, 90089, USA.
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. 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.
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. 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.
Authors: Claudia Carrarini; Mirella Russo; Fedele Dono; Filomena Barbone; Marianna G Rispoli; Laura Ferri; Martina Di Pietro; Anna Digiovanni; Paola Ajdinaj; Rino Speranza; Alberto Granzotto; Valerio Frazzini; Astrid Thomas; Andrea Pilotto; Alessandro Padovani; Marco Onofrj; Stefano L Sensi; Laura Bonanni Journal: Front Neurol Date: 2021-04-16 Impact factor: 4.003
Authors: Howard Fillit; Myrlene S Aigbogun; Patrick Gagnon-Sanschagrin; Martin Cloutier; Mikhaïl Davidson; Elizabeth Serra; Annie Guérin; Ross A Baker; Christy R Houle; George Grossberg Journal: Int J Geriatr Psychiatry Date: 2021-08-27 Impact factor: 3.850