TY - JOUR
T1 - Management of agitation and aggression associated with alzheimer disease
AU - Ballard, Clive G.
AU - Gauthier, Serge
AU - Cummings, Jeffrey L.
AU - Brodaty, Henry
AU - Grossberg, George T.
AU - Robert, Philippe
AU - Lyketsos, Constantine G.
PY - 2009
Y1 - 2009
N2 - 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.
AB - 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.
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U2 - 10.1038/nrneurol.2009.39
DO - 10.1038/nrneurol.2009.39
M3 - Review article
C2 - 19488082
AN - SCOPUS:68349084783
SN - 1759-4758
VL - 5
SP - 245
EP - 255
JO - Nature Reviews Neurology
JF - Nature Reviews Neurology
IS - 5
ER -