Agitation in Alzheimer Disease: What Clinicians Need to Ask, Assess, and Address
A geriatric psychiatrist's clinical pearls on agitation in AD, incluiding behavioral cues, triggers, and evidence-based treatment strategies for primary care.
Agitation in Alzheimer disease (AD) is more than a behavioral complication, it is one of the strongest predictors of caregiver distress, safety concerns, and early institutionalization, according to leading geriatric psychiatirst George T Grossberg, MD, Samuel W. Fordyce professor and director of Geriatric Psychiatry in the Department of Psychiatry at Saint Louis University School of Medicine. In a recent interview with Patient Care, Grossberg discussed the wide range of clinical presenations that signal agitation and the many reasons the symptoms are misunderstood.
A recent study found that nearly two-thirds (64%) of older adults who are diagnosed with any dementia in the US received that diagnosis from a primary care clinician, making the frontline clinicians a key audience for ongoing education. With this in mind, Patient Care editors combed through the conversation with Grossberg and sifted out a collection of his most pointed comments. The quotes above outline why agitation is so frequently overlooked, how to identify it when families don’t use the clinical language for it, and why early recognition can change the trajectory of care. He emphasizes the importance of assessing for medical and environmental triggers, using nonpharmacologic strategies first, and reserving medications for situations where risks and benefits are clearly understood. Grossberg's observations also highlights the evolving therapeutic landscape, including the role of brexpiprazole and emerging agents such as a dextromethorphan and bupropion combination, dexmedetomidine wafers, and cannabinoid-based therapies. The insights offer practical tools to help prmary care clinicians address agitation proactively and thoughtfully
George T Grossberg, MD, is the Samuel W. Fordyce professor and director of Geriatric Psychiatry in the Department of Psychiatry at Saint Louis University School of Medicine. He is a past president of the American Association for Geriatric Psychiatry and of the International Psychogeriatric Association. Grossberg's research focus includes behavioral symptoms in Alzheimer disease and novel therapies for neurocognitive disorders.
