What are the treatment options for agitation in patients with dementia?

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Last updated: May 22, 2025 • View editorial policy

From the Guidelines

Treatment of agitation in dementia should begin with non-pharmacological approaches before considering medications, as recommended by the most recent guidelines 1. When managing agitation in dementia, it is essential to prioritize non-pharmacological strategies, such as identifying and addressing potential triggers, creating a calm environment, and engaging patients in meaningful activities.

Key Considerations

  • Non-pharmacological strategies should be considered as first-line management of an individual with vascular cognitive impairment (VCI) who is displaying behavior changes, including agitation 1.
  • Structured and tailored activities that are individualized and aligned to current capabilities and take into account previous roles and interests may be considered 1.
  • The Canadian Coalition for Seniors’ Mental Health has issued detailed guidelines for managing behavioral symptoms of dementia, which can be referred to for further guidance 1.

Medication Use

When non-pharmacological approaches are insufficient, medications may be considered, but should be used at the lowest effective dose for the shortest duration possible due to increased mortality risks, as highlighted by the American Psychiatric Association practice guideline 2, 3.

  • For acute agitation, low-dose atypical antipsychotics like risperidone, quetiapine, or olanzapine may be used short-term.
  • SSRIs such as citalopram or sertraline can help with depression-related agitation.
  • For patients with Lewy body dementia, avoid antipsychotics and consider cholinesterase inhibitors like rivastigmine.

Patient Safety

Regular reassessment is essential to monitor for side effects and determine if medications can be reduced or discontinued, prioritizing patient safety and minimizing the risk of adverse effects 2, 3.

  • The goal of treatment is to balance symptom management with patient safety, recognizing that agitation often stems from the patient's inability to communicate needs effectively due to cognitive impairment.
  • Decisions about treatment should be made in collaboration with the patient, their family, and healthcare providers, taking into account the individual's unique needs and circumstances 3.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Agitation in Dementia

  • Agitation is a common behavioral syndrome in dementia, characterized by increased motor activity, restlessness, aggressiveness, and emotional distress, affecting approximately 30% of dementia patients 4.
  • The pathophysiological mechanism underlying agitation involves frontal lobe dysfunction, increased sensitivity to noradrenergic signaling, and abnormal reactivity to weak stimuli 4.
  • Several factors can precipitate agitation, including environmental changes, hospitalization, and pharmacological regimens 4.

Non-Pharmacological Interventions

  • Non-pharmacological interventions, such as person-centered care, communication skills training, and adapted dementia care mapping, have been shown to decrease symptomatic and severe agitation in care homes 5.
  • Activities and music therapy can also decrease overall agitation, while sensory intervention can decrease clinically significant agitation 5.
  • Aromatherapy and light therapy have not demonstrated efficacy in reducing agitation 5.

Pharmacological Management

  • Pharmacological management of agitation in dementia often involves the use of antipsychotics, such as risperidone and quetiapine, which can be effective but require careful consideration of potential adverse effects 6.
  • Acetylcholinesterase inhibitors and memantine may also be initiated to enhance cognition, and trazodone can be used to manage insomnia or sundowning 6.
  • Selective serotonin reuptake inhibitors, such as citalopram, can be used to treat agitation, but require monitoring for potential prolongation of the QT interval 6.

Real-World Treatment Patterns

  • Real-world treatment patterns for agitation in dementia often involve the use of antipsychotics, with most patients initiated on treatment within 3 months of the onset of agitation 7.
  • Non-pharmacological therapies are recommended as a first-line approach, but are often underutilized, with only 37.8% of patients in residential care and 21.3% in community-based settings receiving non-pharmacological therapy before initiation of antipsychotics 7.

Efficacy of Pharmacological Treatments

  • A systematic review and network meta-analysis found that dextromethorphan/quinidine, risperidone, and selective serotonin reuptake inhibitors were significantly more efficacious than placebo in alleviating agitation in dementia 8.
  • Haloperidol appeared less efficacious than nearly all comparators, and oxcarbazepine was found to be inferior in terms of treatment continuation 8.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.