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

From the Guidelines

For constant yelling in dementia patients, non-pharmacological strategies should be considered as first-line management, focusing on identifying and addressing underlying causes, creating a calm environment, and using gentle reassurance and simple language. This approach is supported by the most recent and highest quality study, which recommends non-pharmacological strategies as the first line of management for behavior changes in individuals with vascular cognitive impairment (VCI) or dementia 1.

Key Considerations

• Identify and address potential underlying causes like pain, discomfort, hunger, or need for toileting
• Create a calm environment by reducing noise, maintaining consistent routines, and using gentle reassurance with a calm voice and simple language
• Non-pharmacological approaches should be tried first, including music therapy, reminiscence activities, and gentle touch
• If these are insufficient, medications may be considered, but the risks and benefits should be carefully weighed, particularly considering the potential for increased mortality with antipsychotics 1

Medication Considerations

• Antidepressants such as citalopram or trazodone may be considered if anxiety or depression contribute to the behavior
• Pain medications like acetaminophen may be helpful if pain is suspected
• Always start with the lowest effective dose and monitor closely for side effects

Caregiver Support

• Caregiver education and support are crucial in managing constant yelling in dementia patients
• Maintaining your own well-being through respite care and support groups is also essential
• The yelling often represents the person's attempt to communicate needs they can no longer express clearly due to cognitive impairment affecting language and emotional regulation.

From the Research

Treatment Options for Constant Yelling with Dementia

• Non-pharmacological approaches are recommended as the first line of treatment for constant yelling in dementia patients, as they can be effective in reducing symptoms and improving quality of life 2, 3, 4.
• The 5W method is a reliable and easy-to-use method in clinical practice to analyze shouting in dementia, and it can help identify the underlying causes of the behavior 2.
• Redirection techniques have been shown to be effective in reducing vocalization symptoms in dementia patients, and caregiver psychoeducation can help caregivers use these techniques at home 3.
• Environmental factors, such as noise and lighting, can contribute to agitation and yelling in dementia patients, and modifying these factors can help reduce symptoms 5.
• Non-pharmacological interventions, such as memory therapy, ergotherapy, music therapy, and physical exercise, can be effective in reducing behavioral disorders in dementia patients, including yelling 6.

Pharmacological Interventions

• Pharmacological approaches should only be used when non-pharmacological interventions have been tried and failed, and the patient's symptoms are severe and persistent 2, 4.
• Risperidone is a commonly used medication for treating agitation and aggressiveness in dementia patients, but it should be used with caution and under close monitoring 6.
• Antidementia drugs, such as galantamine, donepezil, rivastigmine, and memantine, may also be effective in reducing behavioral disorders in dementia patients, including yelling 6.

Importance of Multidisciplinary Assessment

• A multidisciplinary assessment of the patient's behavior is essential to identify the underlying causes of the yelling and to develop an effective treatment plan 2, 4.
• Caregivers and family members should be actively involved in the planning and implementation of behavioral plans to ensure that the patient receives consistent and supportive care 4.