Agitation in Alzheimer Disease Dementia: Practical Insights for Clinicians

Behavioral and psychological symptoms of dementia occur in >90% of individuals with dementia, and are associated with a faster decline in cognition and function among individuals with dementia.^1,2

Rajesh R. Tampi, MD, MS, DFAPA, DFAAGP, the Psychiatric Times geriatric psychiatry Section Editor, discusses agitation, one of the common behavioral symptoms in patients with Alzheimer disease, emphasizing its impact on morbidity, mortality, caregiver burden, and health care costs. Collateral information from family or caregivers is crucial when the patient is unable to provide a history.

He also stresses the importance of comprehensive evaluation, including history, physical exams, and lab tests, to rule out medical or other psychiatric issues. Rating scales are essential to qualify and quantify symptoms, aiding in the decision to treat with medication. Additionally, the type of agitation determines the treatment approach, with nonpharmacological treatments being the first line of defense.

Nonpharmacological treatments like music therapy and behavioral techniques are initially recommended, but pharmacological options, such as cholinesterase inhibitors, antidepressants, and antipsychotics, are considered for severe cases.

However, Tampi advises against polypharmacy and benzodiazepines for emergent agitation, suggesting specific medications and treatment settings for effective management.

A novel treatment for agitation in Alzheimer disease, Auvelity, was recently approved by the US Food and Drug Administration.³ Tampi believes having a second option, besides brexpiprazole,⁴ will be beneficial to patients with this neurodegenerative disease. To hear more of Tampi’s thoughts on Auvelity, watch this video: “The Approval of Auvelity, the Second Treatment for Alzheimer Disease Agitation.”

Dr Tampi is professor and chair of the Department of Psychiatry at Creighton University School of Medicine and Catholic Health Initiatives Health Behavioral Health Services. He is also an adjunct professor of psychiatry at Yale School of Medicine in New Haven, Connecticut, and a member of the Psychiatric Times editorial board.

References

1. Tampi RR, Jeste DV. Dementia is more than memory loss: neuropsychiatric symptoms of dementia and their nonpharmacological and pharmacological management. Am J Psychiatry. 2022;179(8):528-543.

2. Bachu AK, Subhedar RP, Ansari MI, et al. Treatment options for the management of behavioral and psychological symptoms of dementia. Psychiatric Times. July 18, 2024. https://www.psychiatrictimes.com/view/treatment-options-for-the-management-of-behavioral-and-psychological-symptoms-of-dementia

3. Kuntz L. FDA approves Auvelity for treatment of agitation in Alzheimer disease. Psychiatric Times. April 30, 2026. https://www.psychiatrictimes.com/view/fda-approves-auvelity-for-treatment-of-agitation-in-alzheimer-disease

4. Bachu AK, Subhedar RP, Ansari MI, et al. Evaluating brexpiprazole for the management of behavioral and psychological symptoms of dementia. Psychiatric Times. 2024;41(10).