title: Management of agitation and aggression associated with Alzheimer disease.
abstract: Agitation and aggression are frequently occurring and distressing behavioral and psychological symptoms of dementia (BPSD). These symptoms are disturbing for individuals with Alzheimer disease, commonly confer risk to the patient and others, and present a major management challenge for clinicians. The most widely prescribed pharmacological treatments for these symptoms-atypical antipsychotics-have a modest but significant beneficial effect in the short-term treatment (over 6-12 weeks) of aggression but limited benefits in longer term therapy. Benefits are less well established for other symptoms of agitation. In addition, concerns are growing over the potential for serious adverse outcomes with these treatments, including stroke and death. A detailed consideration of other pharmacological and nonpharmacological approaches to agitation and aggression in patients with Alzheimer disease is, therefore, imperative. This article reviews the increasing evidence in support of psychological interventions or alternative therapies (such as aromatherapy) as a first-line management strategy for agitation, as well as the potential pharmacological alternatives to atypical antipsychotics-preliminary evidence for memantine, carbamazepine, and citalopram is encouraging.
authors.affiliation: King's College London, London, UK. clive.ballard@kcl.ac.uk
authors.forename: Clive G
authors.initials: CG
authors.lastname: Ballard
authors.forename: Serge
authors.initials: S
authors.lastname: Gauthier
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Cummings
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.forename: George T
authors.initials: GT
authors.lastname: Grossberg
authors.forename: Philippe
authors.initials: P
authors.lastname: Robert
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
mesh_terms: D000374:Aggression; D000544:Alzheimer Disease / Q000150:complications*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001521:Behavior Therapy / Q000379:methods; D006801:Humans; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000209:etiology* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D014150:Antipsychotic Agents