Review Article

Management of agitation and aggression associated with Alzheimer disease

  • Nature Reviews Neurology volume 5, pages 245255 (2009)
  • doi:10.1038/nrneurol.2009.39
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Abstract

Agitation and aggression are frequently occurring and distressing behavioral and psychological symptoms of dementia (BPSD). These symptoms are disturbing for individuals with Alzheimer disease, commonly confer risk to the patient and others, and present a major management challenge for clinicians. The most widely prescribed pharmacological treatments for these symptoms—atypical antipsychotics—have a modest but significant beneficial effect in the short-term treatment (over 6–12 weeks) of aggression but limited benefits in longer term therapy. Benefits are less well established for other symptoms of agitation. In addition, concerns are growing over the potential for serious adverse outcomes with these treatments, including stroke and death. A detailed consideration of other pharmacological and nonpharmacological approaches to agitation and aggression in patients with Alzheimer disease is, therefore, imperative. This article reviews the increasing evidence in support of psychological interventions or alternative therapies (such as aromatherapy) as a first-line management strategy for agitation, as well as the potential pharmacological alternatives to atypical antipsychotics—preliminary evidence for memantine, carbamazepine, and citalopram is encouraging.

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Acknowledgements

We thank Cambridge Medical Communication Ltd for expert editorial assistance and Dr. Florinda Rosa for advice on content.

Author information

Affiliations

  1. King's College London, London, UK.

    • Clive G. Ballard
  2. Alzheimer's Disease and Related Disorders Unit, McGill Center for Studies in Aging, Douglas Mental Health University Institute, Montreal, QC, Canada.

    • Serge Gauthier
  3. University of California, Los Angeles, Alzheimer's Disease Center, Los Angeles, CA, USA.

    • Jeffrey L. Cummings
  4. Primary Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.

    • Henry Brodaty
  5. Department of Neurology and Psychiatry, St Louis University School of Medicine, St Louis, MO, USA.

    • George T. Grossberg
  6. Memory Center for Care and Research, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, Nice, France.

    • Philippe Robert
  7. Department of Psychiatry, The Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

    • Constantine G. Lyketsos

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Competing interests

C. G. Ballard has acted as a consultant for Arcadia, Esai, Lundbeck A/S, Novartis and Shire, has received honoraria from Esai, Lundbeck A/S, Novartis and Shire, and has received research support from Lundbeck A/S, Novartis, Shire and Wyeth. S. Gauthier has acted a consultant for and has received grants from Lundbeck and has acted as a consultant for Merz Pharmaceuticals. J. L. Cummings has acted as a consultant for and received honoraria from Forest, Lundbeck, Merz Pharmaceuticals, Pfizer, Janssen and Novartis and holds the copyright for the Neuropsychiatric Inventory (NPI). H. Brodaty has acted as a consultant for and received honoraria and grants from Lundbeck. G. T. Grossberg has acted as a consultant for Forest, Pfizer, Novartis, Medivation and PAM Labs and received grants from Elan and Wyeth. P. Robert has acted as a consultant for and received honoraria and grants from Lundbeck AIS, acted as a consultant for and received grants from Wyeth, received honoraria and grants from Esai Pharma, and received honoraria from Novartis and Janssen. C. G. Lyketsos has acted as a consultant for and received grants from Forest, Wyeth, Novartis and Lilly and has received grants from Pfizer.

Corresponding author

Correspondence to Clive G. Ballard.