Management of agitation and aggression associated with Alzheimer's disease: controversies and possible solutions.
OBJECTIVE
Behavioral and psychological symptoms of dementia (BPSD) are frequent among people with Alzheimer's disease and other dementias, commonly confer risk to the person and others, and present a significant management challenge for clinicians. The purpose of this review is to describe the current state of knowledge regarding management of BPSD, with a particular focus on agitation.


RESULTS
There is increasing evidence to support the value of simple psychological interventions and staff-training programs as a first-line management strategy for agitation prior to pharmacotherapy. The most widely prescribed pharmacological treatments - atypical antipsychotics - have a modest but significant beneficial effect in the short-term treatment of aggression (over 6-12 weeks), but limited benefits in longer term therapy. In addition, there have been increasing concerns regarding the potential for serious adverse outcomes, including stroke and death. The potential pharmacological alternatives to atypical antipsychotics with the most encouraging preliminary evidence include memantine, carbamazepine and citalopram.


CONCLUSIONS
Large prospective, randomized, placebo-controlled trials are needed to establish the role of agents other than neuroleptics as clinical therapies for the treatment of BPSD and studies are urgently needed to evaluate BPSD treatments in non-Alzheimer dementias.
Ballard
Clive
C
Wolfson Centre for Age-Related Diseases, King's College London, London, UK. clive.ballard@kcl.ac.uk
Corbett
Anne
A
Chitramohan
Ramilgan
R
Aarsland
Das
D
D000368:Aged; D000374:Aggression / Q000187:drug effects / Q000523:psychology*; D000544:Alzheimer Disease / Q000150:complications* / Q000523:psychology / Q000628:therapy; D000927:Anticonvulsants / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002491:Central Nervous System Agents / Q000627:therapeutic use*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D000529:Complementary Therapies / Q000379:methods*; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy; D015259:Dopamine Agents / Q000627:therapeutic use; D005852:Geriatric Psychiatry / Q000379:methods; D006801:Humans; D008559:Memantine / Q000627:therapeutic use; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D011595:Psychomotor Agitation / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
D000927:Anticonvulsants; D018687:Antidepressive Agents, Second-Generation; D014150:Antipsychotic Agents; D002491:Central Nervous System Agents; D002800:Cholinesterase Inhibitors; D015259:Dopamine Agents; D018377:Neurotransmitter Agents; D008559:Memantine