Aggression and Agitation in Dementia

M. Uri Wolf, MD, FRCPC; Yael Goldberg, PhD, CPsych; Morris Freedman, MD, FRCPC, FAAN Behavioral Neurology and Psychiatry p. 783-803 June 2018, Vol.24, No.3 doi: 10.1212/CON.0000000000000605
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PURPOSE OF REVIEW: This article reviews the treatment of aggression and agitation in dementia. Both nonpharmacologic and pharmacologic approaches to responsive behaviors are discussed. Practical treatment strategies are applied to common behavioral symptoms.

RECENT FINDINGS: Aggressive and agitated behavior is common in dementia. Behavioral symptoms lead to reduced quality of life and distress for both patients and caregivers. They can also lead to poor outcomes and are associated with significant financial implications for the individual and health care system. A wide range of difficult behaviors exists, with limited evidence for deciding on treatment. Clinicians should integrate the available evidence with practical and commonsense strategies to target these difficult-to-treat behaviors.

SUMMARY: Treating aggression and agitation in dementia is challenging. Viewing behaviors as a response to either internal or external stimuli can help guide treatment. Treatment should emphasize nonpharmacologic approaches as an initial step, using practical and commonsense strategies. Caregivers and family should be actively involved in the planning and implementation of behavioral plans. It is essential to minimize both medical and nonmedical factors that may be contributing to behaviors. When pharmacologic options are required, it is important to choose medications that will target specific behavioral goals, having both practical consideration and the best evidence in mind.

Address correspondence to Dr M. Uri Wolf, Baycrest Health Sciences, 3560 Bathurst St, Toronto, ON M6A 2E1, Canada,

RELATIONSHIP DISCLOSURE: Drs Wolf and Goldberg report no disclosures. Dr Freedman serves as a trustee for the World Federation of Neurology and on the editorial boards of Brain and Cognition and Journal of Parapsychology; has received support from and served on an advisory board for Eli Lilly and Company Canada and receives publishing royalties from Oxford University Press; receives research/grant support from the Alzheimer Society of Canada, Brain Canada Foundation, Centre for Aging and Brain Health Innovation, Canadian Institutes of Health Research, and Westin Brain Institute; receives support from the Behavioural Neurology Physician Recognition Covenant Fund at Baycrest, the Morris Kerzner Memorial Fund, and the Saul A. Silverman Foundation as part of the Canada International Scientific Exchange Program project; and holds stock in companies producing or planning to produce medical marijuana and is listed on a provisional patent related to methods and kits for differential diagnosis of Alzheimer disease.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Wolf, Goldberg, and Freedman discuss the unlabeled/investigational use of medications for the treatment of aggression and agitation in dementia, none of which are approved by the US Food and Drug Administration.


© 2018 American Academy of Neurology