Dr Marc Agronin explains how determining the causes of agitation seen in dementia requires good detective work. The stage is set given the brain damage associated with dementia which impairs affective regulation and executive function, and degrades cholinergic, serotonergic, and dopaminergic pathways.
These changes are enough to cause agitation—but frequently additional medical, psychiatric, psychological, medication-related, or environmental factors actually trigger or exacerbate behavioral disturbances.
A deeper understanding of agitated behaviors can be derived from looking at their context and the function they serve. Applied behavior analysis suggests that disruptive behaviors serve one or more of these five basic functions:
• pain attenuation
• tangible items (eg, food)
• escape from noxious situations
It can take time and multiple interviews to understand the functions but knowing them can guide behavioral treatments.
Dr Agronin is a geriatric psychiatrist and currently serves as the Senior Vice President for Behavioral Health and the Chief Medical office at MIND Institute at Miami Jewish Health in Miami, FL. Dr Agronin was a speaker at the 2019 Psych Congress in San Diego, CA, in a presentation titled “Behavioral and pharmacologic approaches to agitation and dementia associated with major neurocognitive disorders.”