Shared Decision-Making for Agitation in Specialty Care and Disease Trajectory

In "Shared Decision-Making for Agitation in Specialty Care and Disease Trajectory," our experts close out the discussion of shared decision-making and debate whether treating agitation can shift the disease's broader trajectory.

This episode closes out the discussion of shared decision-making by turning to how it unfolds in specialty psychiatric care. Rather than using the clinical term agitation, which patients and caregivers may not relate to, the panel describes framing each specific behavior as something associated with Alzheimer's disease. Behavioral interventions come first, with caregivers explicitly told that, since they live with the patient day to day, they are the ones actually testing what works through trial and error, while the clinician's role is to teach that process and prepare families for behaviors that will keep evolving over time.

When behavioral interventions fail and a behavior is disrupting essential care, such as bathing or medication administration, or exhausting the caregiver, the conversation shifts to medication. That conversation is described as realistic and thorough, covering expected timelines, titration, risks, benefits, and side effects, always paired with a scheduled follow-up rather than an open-ended goodbye, so families know support continues.

The episode also captures a broader debate among the panel about disease trajectory: whether treating agitation, alongside early Alzheimer's diagnosis and monoclonal antibody therapy, meaningfully changes the course of the disease, or simply changes morbidity in the near term. One panelist cites unpublished natural-history data from the Alzheimer's Disease Neuroimaging Initiative showing that patients with higher neuropsychiatric or depression symptom scores decline faster on cognitive staging measures than those with lower scores, a finding the panel takes as objective evidence that unmanaged neuropsychiatric symptoms may themselves help drive measurable decline, not merely accompany it.

Up next, in "Choosing Between Augmentation and Switching for Agitation Therapy," the experts examine how clinicians decide between augmenting and switching therapy.