Agitation in Patients With Dementia: A Practical Guide to Diagnosis and Management

“Agitation” is the term currently applied to a wide range of disruptive behaviors exhibited by the demented elderly and other patients with severe brain damage. One classification system groups behaviors according to the independent dimensions of aggressive-nonaggressive and physical-verbal-vocal. This scheme is probably useful in identifying risk to patients and caregivers, but it has not as yet proved useful in identifying neurochemical correlates or pharmacotherapies for agitation.

After consideration of the issues of terminology and measurement, additional chapters are devoted to epidemiology, ethical-legal issues, drug and hormone therapy, and nonpharmacological therapies ranging from psychotherapy to ECT. Although support for the usefulness of each form of therapy is claimed, typically the evidence is sparse and limited to reports of a few cases. The contrast in the poor quality of the research on agitation in dementia with the many large double-blind, placebo-controlled drug trials on cognition in dementia is quite striking. The reason is unclear in view of the fact that almost 50% of dementia patients exhibit some form of agitation at any one point in time. A second observation about the literature is that the majority of studies of treatment have been done in nursing homes. Although agitation, particularly wandering and physical aggression, appears to be more common in nursing home populations, agitation poses a much more serious management problem for caregivers who live with a demented person than does cognitive decline. After incontinence, agitation is the second most cited reason for placing a demented relative in a nursing home. If caregivers could be provided with better ways of dealing with agitation, the benefits for them and for the health care system could be substantial. Apparently, however, this sort of research has not been done.

It is certainly not the fault of the authors or editors, but there really isn’t much new in this book. The state of the art is summarized by editor Donald P. Hay, reflecting on his feelings after receiving a call in the middle of the night from nursing home staff about an agitated, disruptive patient. He states, “We often wish that we had a magic pill or a surefire technique to recommend, but unfortunately we do not.”