title: Agitation and Irritability in Alzheimer's Disease: Evidenced-Based Treatments and the Black-Box Warning.
abstract: More than five million Americans suffer from Alzheimer's disease (AD), and this number is expected to triple by 2050. While impairments in cognition, particularly memory, are typically the defining features of the clinical syndrome, behavioral symptoms are extremely common, affecting up to 90% of patients. Behavioral symptoms in AD can be difficult to manage and may require a combination of non-pharmacological and pharmacological approaches. The latter is complicated by FDA "black-box warnings" for the medication classes most often used to target these symptoms, and currently there are initiatives in place to limit their use. In this review, we describe common behavioral symptoms of AD-with a particular focus on the challenging symptoms of "agitation" and "irritability"-and discuss evidence-based approaches to their management. Ultimately, multidimensional approaches must be tailored to the patient and their environment, though evidence-based practices should define the treatment of agitation and irritability in AD.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. amkoenig@mgh.harvard.edu.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. amkoenig@mgh.harvard.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Koenig
authors.affiliation: MassGeneral Institute for Neurodegenerative Disease, Boston, MA, USA.|Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Arnold
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.|Behavioral Health Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
mesh_terms: D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology; D032763:Behavior Control / Q000379:methods*; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003071:Cognition; D055317:Evidence-Based Practice; D006801:Humans; D007508:Irritable Mood; D011595:Psychomotor Agitation / Q000209:etiology / Q000628:therapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs
keywords: Alzheimer’s disease; Black-box warning; Neuropsychiatric symptoms; Non-pharmacological approaches; Pharmacological approaches