Agitation in patients with dementia

Debra R Kahn, Raheel A. Khan, James A. Bourgeois

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Typical consult question “A seventy-two year old man with a history of Parkinson's disease is admitted to the hospital for placement because his family ‘can't handle him anymore.’ The patient has been paranoid and frequently refuses medications. Please help us with management.” Background Dementia is an increasingly frequent and costly disease of our aging population. An estimated 5% to 15% of the U.S. population over the age of 65 has dementia. Worldwide estimates are 25 million with an expected doubling by 2020. Neuropsychiatric symptoms occur in more than 80% of those with Alzheimer's disease (AD). Symptoms may include mood disorders, sleep disturbance, irritability, aggression, psychosis, and agitation. Behavioral and mood disturbances in patients with dementia are associated with patient and caregiver distress, greater impairment in activities of daily living (ADLs), decreased cognition, increased care costs, and nursing home placement. Among the most troubling neuropsychiatric symptoms is agitation, found in 40% to 60% of nursing home patients with AD. Similar rates of agitation and psychosis have been found in patients with vascular dementia. Cohen-Mansfield (2001) delineated several categories of “inappropriate behavior” associated with dementia, summarized as follows: Physically aggressive behaviors (e.g., hitting, kicking, biting) Motoric restlessness that is not aggressive (e.g., pacing, repetitive mannerisms) Verbalizations (e.g., perseverations, cursing, screaming) Agitation in patients with dementia may present acutely, follow a “waxing and waning” course, or develop slowly over months to years.

Original languageEnglish (US)
Title of host publicationPsychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry
PublisherCambridge University Press
Pages89-99
Number of pages11
ISBN (Electronic)9780511776878
ISBN (Print)9780521106658
DOIs
StatePublished - Jan 1 2010

ASJC Scopus subject areas

  • Medicine(all)

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    Kahn, D. R., Khan, R. A., & Bourgeois, J. A. (2010). Agitation in patients with dementia. In Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry (pp. 89-99). Cambridge University Press. https://doi.org/10.1017/CBO9780511776878.011