Treatment of Agitation in Older Persons with Dementia

This guideline publication has subsequently been updated. For the most up-to-date recommendations on this disorder, you should access Treatment of Dementia and Agitation: A Guide for Families and Caregivers (2005) in pdf, Small print

Alexopoulos GS, Silver JM, Kahn DA, Frances A, Carpenter D, eds. The Expert Consensus Guidelines™: Agitation in Older Persons with Dementia. A Postgraduate Medicine Special Report. April 1998. The McGraw-Hill Companies, Inc.

The agitation that can occur in association with dementia greatly complicates patient care, poses a risk to the patient's health and safety, and significantly increases the burden for families and caregivers. Based on a survey of 84 experts in geriatric psychiatry, these guidelines cover assessment of agitation in dementia, overall management strategies, and selection of environmental interventions and medications. Recommendations are given for selecting medications and environmental strategies to manage delirium, psychosis, depression, anxiety, insomnia, "sundowning," other types of aggression or anger, and pain that occur in the context of dementia. Guidelines are also provided concerning medication dosing, side effects, safety, and tolerability; managing inadequate response to medication; and long-term treatment issues. The guidelines include schematic treatment algorithms for selecting general management strategies and choosing medications for specific types of agitation. Also included is "A Guide for Families and Caregivers" that was developed with the assistance of the American Federation for Aging Research, the American Association for Retired Persons, and the National Citizens' Coalition for Nursing Home Reform.

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