Agitation in Alzheimer's Dementia (AAD)
Why Early Detection Is Important
Agitation Is a Common Manifestation in Patients With Alzheimer's Dementia1
Estimated number of U.S. adults aged ≥65 years living with Alzheimer’s dementia:
It is estimated the number will almost double by 2060.1
What Is Agitation in Alzheimer's Dementia (AAD)?
People with Alzheimer’s dementia can experience behavioral and psychological conditions, with agitation being the most common.1-4
Agitation in Alzheimer’s dementia is a common and treatable condition with a broad range of symptoms. It requires management strategies distinct from those used for cognitive impairment.5-7
Agitation Can Manifest as Both Non-Aggressive and Aggressive Behaviors6,20
Non-aggressive behaviors such as wandering, pacing, and repetitive questions may not be immediately recognized as part of agitation and are often dismissed as acting out.
Excessive Motor Activity Behaviors6:
Pacing
Restlessness
Rocking
Pointing fingers
Gesturing
Performing repetitious mannerisms
Verbal Aggression Behaviors6:
Yelling
Speaking in an excessively loud voice
Using profanity
Screaming
Shouting
Physical Aggression Behaviors6:
Grabbing
Shoving
Pushing
Hitting others
Resisting
Kicking objects or people
Scratching
Biting
Throwing objects
Hitting self
Slamming doors
Tearing things
Destroying property
Agitation Is Prevalent Across Care Settings and Alzheimer's Dementia Severities8
Caregivers often notice these non-aggressive symptoms, such as wandering, pacing, and repetitive questions, but may not recognize or understand them. It’s important to recognize these symptoms and share them with Healthcare Providers (HCPs) to help drive timely diagnosis and treatment for agitation in Alzheimer’s dementia.10
Care Setting8,9
Alzheimer’s Dementia Severityb,c,1
Although agitation occurs more frequently in patients with moderate to severe Alzheimer's dementia, it can occur in patients with milder dementia as well.8
aNursing home percentage reported includes those with dementia due to Alzheimer’s disease and other types of dementia.
bOf the 320,886 eligible patients, 78,827 (24.6%) could be assigned to explicit AD/dementia severity categories over a 2-year period.
cAdapted from a retrospective database study of 320,886 community-dwelling patients with ≥1 electronic health record (EHR) indicating Alzheimer’s disease/dementia. Agitation was identified using diagnosis codes for dementia with behavioral disturbance and EHR abstracted notes records indicating agitation symptoms compiled from the International Psychogeriatric Association provisional consensus definition. Patients who had records containing valid quantitative MMSE scores or explicit terms for only one level of AD/dementia severity were categorized accordingly as “mild,” “moderate,” or “severe".
Agitation Is One of the Most Costly Aspects of Alzheimer's Dementia Care and Increased Healthcare Resource Utilization2-4
The presence of agitation may increase the likelihood of patients with Alzheimer's dementia being placed in long-term care (LTC) facilities.9
Agitation in Alzheimer’s Dementia Is Associated With Significant Negative Patient Outcomes and High Caregiver Burden8,11
Agitation in patients with Alzheimer’s dementia has been associated with significant caregiver burden that increases with severity. It is a factor for burnout, reduced workability, and overall poorer health among caregivers. These negative outcomes are common to both professional and family caregivers.4,11-15
General health decline
Reduced quality of life
Depression
Anxiety
Embarrassment & guilt
Social isolation
Increased use of clinical services
Overall, agitation versus no agitation in patients with Alzheimer’s dementia has been associated with8,9,21-25:
Accelerated disease progression
Functional decline
Decreased quality of life
Greater comorbidities
Increased use of concomitant therapies
Increased risk of hospitalization/
Earlier death
In long-term care, agitation in Alzheimer’s dementia has been associated with these additional consequences9:
Falls
Fractures
Infections
Higher medication use
Other neuropsychiatric symptoms
Current Treatment Paradigm
Differential Diagnosis
General medical, psychiatric, environmental, or psychosocial problems16,17
Individualize
Each plan is tailored to the individuals' symptoms, needs, and overall health4
Non-Pharmacological Intervention
As the first step in treatment, non-pharmacological interventions such as lifestyle changes, behavioral therapies, or environmental modifications may be used to help manage agitation18
Pharmacological Intervention
If non-pharmacological measures are unsuccessful or behaviors are dangerous or distressing, medication may help manage and reduce symptoms18
Interested in learning about the AASC® development?
Reference(s)
1. Alzheimer’s Association. 2024 Alzheimer’s Disease Facts and Figures. Alzheimers Dement 2024;20(5). 2. Antonsdottir IM, et al. Expert Opin Pharmacother. 2015;16(11):1649-1656. 3. Anatchkova M, et al. Int Psychogeriatr. 2019;31(9):1305-1318. 4. Kales HC, et al. BMJ. 2015;350:h369 5. Cohen-Mansfield J. Instruction Manual for the Cohen-Mansfield Agitation Inventory (CMAI). 1991. Rockville, MD: Research Institute of the Hebrew Home of Greater Washington. 6. Sano M, et al. Int Psychogeriatr. 2023;1-13. 7. Gilmore-Bykovskyi A, et al. Gerontologist. 2020;60(5):896-904. 8. Halpern R, et al. Int J Geriatr Psychiatry. 2019;34(3):420-431. 9. Fillit H, et al. Int J Geriatr Psychiatry. 2021;36(12):1959-1969. 10. Clevenger C, et al. Study protocol: quantitative evaluation of The Agitation in Alzheimer’s Screener for Caregivers (AASC), a novel tool for improving recognition of agitation in Alzheimer’s dementia. Alzheimer’s Association International Conference (AAIC): July 28-August 1, 2024: Philadelphia, PA. 11. Schein J, et al. J Alzheimers Dis. 2022;88(2):663-677. 12. Palm R, et al. J Alzheimers Dis. 2018;66(4):1463-1470. 13. Isik AT, et al. Int J Geriatr Psychiatry. 2019;34(9):1326-1334. 14. Brodaty H and Hadzi-Pavlovic D. Aust N Z J Psychiatry. 1990;24(3):351-361. 15. Patrick KS, et al. Psychogeriatrics. 2022;22(5):688-698. 16. Carrini C, et al. Front Neurol. 2021;12:644317. 17. Nordstrom K, et al. West J Emerg Med. 2012;13(1):3-10. 18. Reus IV, et al. Am J Psychiatry. 2016;173(5):543-546. 19. Cohen-Mansfield J. J Psychiatr Res. 2008;43(1):64-69. 20. Rabinowitz J, et al. Am J Geriatr Psychiatry. 2005;13(11):991-998. 21. Jones E, et al. J Alzheimers Dis. 2021;83(1):89-101. 22. Koenig AM, et al. Curr Psychiatry Rep. 2016;18(1):3. 23. Peters ME, et al. Am J Psychiatry. 2015;172(5):460-465. 24. Scarmeas N, et al. Arch Neurol. 2007;64(12):1755-1761. 25. Banerjee S, et al. J Neurol Neurosurg Psychiatry. 2006;77(2):146-148.