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Agitation in DementiaAka: Dementia Related Agitation
- See Also
- Dementia
- Dementia Management
- No-fail Environment in Dementia
- Dementia Related Malnutrition
- Behavior Problems in Dementia
- Sleep Problems in Dementia
- Wandering Behavior in Dementia
- Etiology of Behavior Decompensation (The 6 I's)
- Iatrogenic
- Anticholinergic Medications
- Sedative-Hypnotic Medications
- Infection
- Urinary Tract Infection
- Pneumonia
- Injury
- Hip Fracture
- Illness exacerbation
- Diabetes Mellitus
- Chronic Obstructive Pulmonary Disease (COPD)
- Major Depression
- Impaction of feces
- Inconsistency in environment or routine change
- Other
- Thirst or hunger
- Drug or Alcohol use
- Caffeine
- Catastrophic Reaction
- Results from Task failure
- Patient told that they're wrong
- Symptoms
- Irritability
- Accusation
- Tearful
- Combative
- Management: Non-Pharmacologic
- See No-fail Environment in Dementia
- Reaction to physical Care
- Occurs particularly in frontal lobe Impairment
- Patients Akinetic
- Patient wants to be left alone
- Management: Non-Pharmacologic
- Limit goals (e.g. bath less often)
- Follow strict routine at patient's best time of day
- Use slow gentle movements in physical care
- Approach patient from side or rear
- Reassure ("As soon as we're done, I'll stop")
- Screaming
- Often no purpose
- Associated with non-directed agitation
- Cause may be multifactorial
- Pain
- Sensory deprivation
- Restraints
- Depression in Dementia
- Treat possible underlying causes
- Aggression-Specific Types/Other Causes
- Disinhibition
- Agitated depression
- Management: Medications
- Indications
- Failed Behavior Modification as above
- Severe and refractory agitation
- Medication preparations
- Antipsychotics (all agents with similar efficacy)
- Old, cheap drugs with high extrapyramidal effects
- Haloperidol 0.5 mg PO bid ($5/month)
- Useful as initial agent in acute agitation
- Switch to agent below if need to continue
- Avoid in Parkinson's Disease
- Markedly impairs mobility secondary to rigidity
- New, costly drugs with low extrapyramidal effects
- Risperidone (Risperdal) 0.5 mg bid ($78/month)
- Quetiapine (Seroquel) 25 mg PO bid ($85/month)
- Indicated for Parkinson's Disease
- Other agents with potential benefi
- Divalproex (Depakote)
- Carbamazepine (Tegretol) titrate to 300 mg/day
- Limited by Sedation, narrow therapeutic window
- Trazodone (Desyrel) 50 mg PO qhs
- Selective Serotonin Reuptake Inhibitor
- Newer Tricyclic Antidepressants (e.g. Pamelor)
- Agents with only anecdotal support
- Beta Blockers (e.g. Propranolol)
- Lithium
- Buspirone (Buspar)
- Agents to use with only with caution
- Benzodiazepines: Lorazepam (Ativan) 0.25 - 0.50 mg
- Give 30 minutes prior to physical care
- May cause Ataxia, risk of falls
- References
- Howell in Duthie (1998) Geriatrics p. 295-305
- Ham (1997) Postgrad Med 101(6):57
- Stewert (1995) Am Fam Physician 52(8):2311
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