From the Guidelines
Agitation in elderly patients with dementia should be treated with non-pharmacological interventions as the first line of treatment, avoiding medications that prolong the QT interval.
Treatment Options
- Non-pharmacological interventions are recommended as the first line of treatment for agitation in elderly patients with dementia, as they have been shown to be effective in reducing symptoms and improving quality of life 1.
- Antipsychotic medications should only be used in severe cases where symptoms are dangerous and/or cause significant distress to the patient, and with careful monitoring of potential adverse effects 1.
- Person-centered care and psychosocial interventions are essential in managing behavioral and psychological symptoms of dementia (BPSD) and supporting quality of life in patients with dementia 1.
Medication Considerations
- Avoid medications that prolong the QT interval, as they can increase the risk of adverse cardiac effects in elderly patients with dementia.
- Use of antipsychotic medications should be carefully considered, as they are associated with clinically significant adverse effects, including mortality 1.
Key Principles
- Individualized treatment plans should be developed based on the patient's specific needs and circumstances, taking into account their goals, preferences, and values.
- Collaboration with caregivers and family members is essential in managing agitation and providing support to patients with dementia.
From the Research
Treatment Options for Agitation in Elderly Patients with Dementia
To manage agitation in elderly patients with dementia, several treatment options are available, with a focus on avoiding medications that prolong the QT interval.
- Non-pharmacological approaches should be considered first, as they are often effective in managing agitation and have fewer side effects 2, 3.
- If non-pharmacological approaches are not effective, pharmacological options can be considered.
- Acetylcholinesterase inhibitors and memantine may be initiated to enhance cognition, and trazodone can be used to manage insomnia or sundowning 4.
- Citalopram can be used to treat agitation, but its potential to prolong the QT interval should be carefully monitored 4.
- Atypical antipsychotics such as risperidone or quetiapine can be effective, but their use should be carefully considered due to potential adverse effects, including an increased risk of mortality 2, 4, 5.
- Complementary and alternative medicine (CAM) modalities, such as music therapy, aromatherapy, and massage, may also be beneficial in reducing agitation and delirium in older persons with dementia 3.
- Selective serotonin reuptake inhibitors (SSRIs) and dextromethorphan/quinidine have shown efficacy in alleviating agitation in dementia, although the evidence for dextromethorphan/quinidine is based on a single randomized controlled trial 5.
Medications to Avoid
Medications that prolong the QT interval, such as certain antipsychotics and antidepressants, should be avoided or used with caution in elderly patients with dementia due to the increased risk of cardiac arrhythmias and other adverse effects 4, 5.
- Haloperidol and oxcarbazepine are not recommended due to their lack of efficacy and acceptability, respectively 5.