psychosis, agitation & difficult behavior in the elderly

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Classification

Etiology

Epidemiology

Pathology

Genetics

Clinical manifestations

* see Cohen-Mansfield Agitation Inventory (CMAI)

Laboratory

Radiology

Complications

Management

specific therapies for specific etiologies

* demented patients may not be able to tell you they are in pain

* look for signs of pain & behaviors that may be attributable to pain[86]

behavioral & general measures are 1st line (also see OBRA)

pharmaceutical agents

new directions

* see atypical vs conventional antipsychotics in the elderly

Notes

More general terms

Additional terms

References

  1. Sultzer, D. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. 2.0 2.1 Prescriber's Letter 8(7):40 2001 Doody RS et al, Practice Parameter: management of dementia (an evidence-based review). Report of the quality standards subcommitte of the American Academy of Neurology, Neurology 56:1154-1156, 2001 (Guideline withdrawn 02/2009) PMID: https://www.ncbi.nlm.nih.gov/pubmed/11342679
  3. Sultzer, D. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
  4. 4.0 4.1 Journal Watch 24(17):133, 2004 Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ. 2004 Jul 10;329(7457):75. Epub 2004 Jun 11. Review. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15194601 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7457/75
  5. 5.0 5.1 5.2 Rovner BW, German PS, Broadhead J, Morriss RK, Brant LJ, Blaustein J, Folstein MF. The prevalence and management of dementia and other psychiatric disorders in nursing homes. Int Psychogeriatr. 1990 Spring;2(1):13-24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/2101294
  6. FDA Public Health Advisory Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances http://www.fda.gov/cder/drug/advisory/antipsychotics.htm http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#atypical
  7. Prescriber's Letter 12(6): 2005 Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210604&pb=PRL (subscription needed) http://www.prescribersletter.com
  8. 8.0 8.1 8.2 Journal Watch 25(12):96, 2005
    Ballard C, Margallo-Lana M, Juszczak E, Douglas S, Swann A, Thomas A, O'Brien J, Everratt A, Sadler S, Maddison C, Lee L, Bannister C, Elvish R, Jacoby R. Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. BMJ. 2005 Apr 16;330(7496):874. Epub 2005 Feb 18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15722369
    Gauthier S Drugs for Alzheimer's disease and related dementias. BMJ. 2005 Apr 16;330(7496):857-8. No abstract available. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15831849 <Internet> http://bmj.bmjjournals.com/cgi/content/full/330/7496/874
  9. Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005 Dec 1;353(22):2335-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319382
    Ray WA. Observational studies of drugs and mortality. N Engl J Med. 2005 Dec 1;353(22):2319-21. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319379
  10. 10.0 10.1 Schneider LS Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease N Engl J Med 2006, 355:1525 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17035647
    Karlawish J Alzheimer's disease - Clinical trials and the logic of clinical purpose. N Engl J Med 2006, 355:1604 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17035654
  11. Ballard C, Waite J. The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD003476. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16437455
  12. Cummmins JL et al, for Memantine MEM-MD-02 Study Group Behavioral effects memantine in Alzheimer disease patients receiving donepezil treatment. Neurology 2006, 67:57 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16832078
  13. 13.0 13.1 13.2 Schneeweiss S et al, Risk of death with use of conventional versus atypical antipsychotic drugs among elderly patients. CMAJ 2007, 176:627 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17325327
  14. 14.0 14.1 Howard RJ et al, Donepezil for the treatment of agitation in Alzheimer's disease. N Engl J Med 2007, 357:1382 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17914039
  15. 15.0 15.1 Kales HC, Valenstein M, Kim HM, McCarthy JF, Ganoczy D, Cunningham F, Blow FC. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry. 2007 Oct;164(10):1568-76. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17898349
  16. 16.0 16.1 Yaffe K. Treatment of neuropsychiatric symptoms in patients with dementia. N Engl J Med 2007, 357:1411 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17914047
  17. 17.0 17.1 Rochon PA et al, Antipsychotic Therapy and Short-term Serious Events in Older Adults With Dementia Arch Intern Med 2008 168:1090 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18504337
  18. FDA MedWatch http://www.fda.gov/medwatch/safety/2008/safety08.htm#Antipsychotics
  19. Sultzer DL et al. Clinical symptom responses to atypical antipsychotic medications in Alzheimer's disease: Phase 1 outcomes from the CATIE-AD effectiveness trial. Am J Psychiatry 2008 Jul; 165:844 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18519523
    Kuehn BM. FDA: Antipsychotics risky for elderly. JAMA 2008 Jul 23/30; 300:379 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18647971
  20. 20.0 20.1 Douglas IJ and Smeeth L. Exposure to antipsychotics and risk of stroke: Self controlled case series study. BMJ 2008 Aug 28; 337:a1227. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18755769
  21. 21.0 21.1 21.2 Ballard C et al The dementia antipsychotic withdrawal trial (DART-AD): Long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009 Feb; 8:151. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19138567 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(08)70295-3/fulltext
  22. 22.0 22.1 Tariot PN et al. for the Alzheimer's Disease Cooperative Study Group. Chronic divalproex sodium to attenuate agitation and clinical progression of Alzheimer disease. Arch Gen Psychiatry 2011 Aug; 68:853. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21810649
  23. Prescriber's Letter 18(10): 2011 CHART: Pharmacotherapy of Dementia Behaviors CHART: Pharmacotherapy of Dementia Behaviors Algorithm GUIDELINES: American Psychiatric Association Dementia Guideline Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271010&pb=PRL (subscription needed) http://www.prescribersletter.com
  24. 24.0 24.1 Devanand DP et al Relapse Risk after Discontinuation of Risperidone in Alzheimer's Disease N Engl J Med 2012; 367:1497-1507 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23075176 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1114058
  25. 25.0 25.1 Campbell N, Boustani MA, Ayub A, et al. Pharmacological management of delirium in hospitalized adults- a systematic evidence review. J Gen Intern Med 2009; 24:848-853 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19424763
  26. Husebo BS, Ballard C, Sandvik R, et al. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ 2011; 343:d4065 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21765198
  27. 27.0 27.1 Lopez OL et al. The long-term effects of conventional and atypical antipsychotics in patients with probable Alzheimer's disease. Am J Psychiatry 2013 Jul 30 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23896958 <Internet> http://ajp.psychiatryonline.org/article.aspx?articleID=1722043
  28. Ballard C, Corbett A. Agitation and aggression in people with Alzheimer's disease. Curr Opin Psychiatry. 2013 May;26(3):252-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23528917
    Ballard C, Corbett A. Management of neuropsychiatric symptoms in people with dementia. CNS Drugs. 2010 Sep;24(9):729-39. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20806986
  29. 29.0 29.1 Porsteinsson AP et al Effect of Citalopram on Agitation in Alzheimer Disease. The CitAD Randomized Clinical Trial. JAMA. 2014;311(7):682-691 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24549548 https://jama.jamanetwork.com/article.aspx?articleid=1829989
    Small GW Treating Dementia and Agitation. JAMA. 2014;311(7):677-678 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24549545 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1829969
  30. Iglewicz A1, Meeks TW, Jeste DV. New wine in old bottle: late-life psychosis Psychiatr Clin North Am. 2011 Jun;34(2):295-318, vii. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21536160
  31. 31.0 31.1 31.2 Rodda J1, Morgan S, Walker Z. Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. Int Psychogeriatr. 2009 Oct;21(5):813-24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19538824
  32. 32.0 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
    Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
    Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
    Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  33. Weintraub D, Hurtig HI. Presentation and management of psychosis in Parkinson's disease and dementia with Lewy bodies. Am J Psychiatry. 2007 Oct;164(10):1491-8. Review. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17898337
  34. 34.0 34.1 Brodaty H, Arasaratnam C. Review: Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. Am J Psychiatry. 2012;169:946-953 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22952073
  35. Ballard C, Brown R, Fossey J et al Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial). Am J Geriatr Psychiatry. 2009 Sep;17(9):726-33. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19700946
  36. Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc. 2010 Aug;58(8):1465-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20662955
  37. 37.0 37.1 Chen Y, Briesacher BA, Field TS, Tjia J, Lau DT, Gurwitz JH. Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med. 2010 Jan 11;170(1):89-95 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20065204
  38. 38.0 38.1 Kamble P, Chen H, Sherer JT, Aparasu RR. Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs Aging. 2009;26(6):483-92. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19591523
  39. 39.0 39.1 Lester P, Kohen I, Stefanacci RG, Feuerman M. Antipsychotic drug use since the FDA black box warning: survey of nursing home policies. J Am Med Dir Assoc. 2011 Oct;12(8):573-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21450177
  40. 40.0 40.1 Lonergan E, Luxenberg J. Valproate preparations for agitation in dementia. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD003945. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19588348
  41. Salzman C, Jeste DV, Meyer RE et al Elderly patients with dementia-related symptoms of severe agitation and aggression: consensus statement on treatment options, clinical trials methodology, and policy. J Clin Psychiatry. 2008 Jun;69(6):889-98. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18494535
  42. 42.0 42.1 42.2 Prescriber's Letter 21(6): 2014 Preventing and Treating Delirium in Inpatients Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300612&pb=PRL (subscription needed) http://www.prescribersletter.com
  43. Choosing Wisely: Five Things Physicians and Patients Should Question. An Initiative of the ABIM Foundation. American Geriatrics Society http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/choosingwisely
  44. 44.0 44.1 44.2 44.3 Cohen-Mansfield J, Thein K, Marx MS, et al. Sources of discomfort in persons with dementia. JAMA Intern Med. 2013;173(14):1378-1379 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23877083
  45. 45.0 45.1 Cummings JL. Lyketsos CG, Peskind ER et al Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia. A Randomized Clinical Trial. JAMA. 2015;314(12):1242-1254 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26393847 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2442936
    Ballard C, Sharp S, Anne Corbett A Dextromethorphan and Quinidine for Treating Agitation in Patients With Alzheimer Disease Dementia JAMA. 2015;314(12):1233-1235. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26393843 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2442913
  46. 46.0 46.1 46.2 46.3 46.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2021
    Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  47. Barr J, Fraser GL, Puntillo K et al Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013 Jan;41(1):263-306. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23269131
  48. 48.0 48.1 Ballard C et al. Impact of antipsychotic review and nonpharmacological intervention on antipsychotic use, neuropsychiatric symptoms, and mortality in people with dementia living in nursing homes: A factorial cluster-randomized controlled trial by the Well-Being and Health for People with Dementia (WHELD) program. Am J Psychiatry 2015 Nov 20; PMID: https://www.ncbi.nlm.nih.gov/pubmed/26585409
  49. Corbett A, Burns A, Ballard C. Don't use antipsychotics routinely to treat agitation and aggression in people with dementia. BMJ. 2014;349:g6420 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25368388
  50. 50.0 50.1 Schneider LS et al. Heterogeneity of treatment response to citalopram for patients with Alzheimer's disease with aggression or agitation: The CitAD randomized clinical trial. Am J Psychiatry 2016 Jan 15 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26771737 <Internet> http://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2015.15050648
  51. Agency for Healthcare Research and Quality (AHRQ) Executive Summary. March 21, 2016 Nonpharmacologic Interventions for Agitation and Aggression in Dementia. https://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2198
  52. 52.0 52.1 Reus VI, Fochtmann LJ, Eyler AE et al The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia. Am J Psychiatry. 2016 May 1;173(5):543-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27133416
  53. Reinhardt MM, Cohen CI. Late-life psychosis: diagnosis and treatment. Curr Psychiatry Rep. 2015 Feb;17(2):1. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25617038
  54. Steinberg M, Lyketsos CG. Atypical antipsychotic use in patients with dementia: managing safety concerns. Am J Psychiatry. 2012 Sep;169(9):900-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22952071 Free PMC Article
  55. Rossom RC, Rector TS, Lederle FA, Dysken MW. Are all commonly prescribed antipsychotics associated with greater mortality in elderly male veterans with dementia? J Am Geriatr Soc. 2010 Jun;58(6):1027-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20487081
  56. Kales HC, Gitlin LN, Lyketsos CG et al Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J Am Geriatr Soc. 2014 Apr;62(4):762-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24635665 Free PMC Article
  57. 57.0 57.1 Patel AN, Lee S, Andrews HF et al. Prediction of relapse after discontinuation of antipsychotic treatment in Alzheimer's disease: The role of hallucinations. Am J Psychiatry 2016 Nov 18; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27855483
  58. 58.0 58.1 Agar MR, Lawlor PG, Quinn S et al Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care. A Randomized Clinical Trial. JAMA Intern Med. Published online December 5, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27918778 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2588810
  59. 59.0 59.1 Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015 Mar 2;350:h369 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25731881
  60. Pieper MJ, Francke AL, van der Steen JT, et al. Effects of a stepwise multidisciplinary intervention for challenging behavior in advanced dementia: a cluster randomized controlled trial. J Am Geriatr Soc. 2016;64(2):261-269 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26804064
  61. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. Br J Psychiatry. 2014;205(6):436-442 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25452601 Free full text
  62. Lim LS. ACP Journal Club. Review: In patients with dementia who live in care homes, some nondrug interventions reduce agitation. Ann Intern Med. 2015 Jun 16;162(12):JC3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26075780
  63. 63.0 63.1 Herzig SJ, LaSalvia MT, Naidus E et al. Antipsychotics and the risk of aspiration pneumonia in individuals hospitalized for nonpsychiatric conditions: A cohort study. J Am Geriatr Soc 2017 Dec; 65:2580. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29095482 https://doi.org/10.1111/jgs.15066
  64. 64.0 64.1 64.2 NEJM Question of the Week. Feb 27, 2018 https://knowledgeplus.nejm.org/question-of-week/1616/
  65. 65.0 65.1 Ballard C, Corbett A, Orrell M et al Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: A cluster-randomised controlled trial. PLoS Medicine. February 6, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29408901 Free PMC Article <Internet> http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002500
  66. 66.0 66.1 Maust DT, Kim HM, Chiang C et al Association of the Centers for Medicare & Medicaid Services' National Partnership to Improve Dementia Care With the Use of Antipsychotics and Other Psychotropics in Long-term Care in the United States From 2009 to 2014. JAMA Intern Med. Published online March 17, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29550856 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2674245
  67. 67.0 67.1 67.2 Park Y, Bateman BT, Kim DH, et al Use of haloperidol versus atypical antipsychotics and risk of in-hospital death in patients with acute myocardial infarction: cohort study. BMJ 2018;360:k1218 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29592958 https://www.bmj.com/content/360/bmj.k1218
  68. 68.0 68.1 Monaco K Nabilone Effective for Easing Agitation in Alzheimer's - Cognition, neuropsychiatric symptoms also improved with synthetic cannabinoid. MedPage Today. July 25, 2018 https://www.medpagetoday.com/meetingcoverage/aaic/74214
    Lanctot K, et al Nabilone significantly improves agitation/aggression in patients with moderate-to-severe AD: Preliminary results of a placebo- controlled, double-blind, cross-over trial. Alzheimer's Association International Conference (AAIC) 2018; Abstract F4-02-04.
  69. 69.0 69.1 Watt JA, Goodarzi Z, Veroniki AA et al Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis. Ann Intern Med. 2019. Oct 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31610547 https://annals.org/aim/article-abstract/2753018/comparative-efficacy-interventions-aggressive-agitated-behaviors-dementia-systematic-review-network
  70. 70.0 70.1 Monaco K Trial: Drug Induces, Maintains Dementia-Related Psychosis Remission - Results pave way for Nuplazid label expansion. MedPage Today September 14, 2020 https://www.medpagetoday.com/meetingcoverage/psychcongress/88607
    Foff E, et al Pimavanserin significantly reduces risk of relapse of dementia-related psychosis: results from the double-blind phase of the HARMONY study. Psych Congress 2020; Poster #187
    Foff E, et al Response to pimavanserin treatment in patients with dementia-related psychosis: results From the 12-week, open-label phase of the HARMONY study. Psych Congress 2020; Poster #197
    Grant K Staying on Pimavanserin Cut Dementia-Related Psychosis Relapse. However, late-stage trial couldn't separate efficacy in dementia subtypes. MedPage Today July 21, 2021 https://www.medpagetoday.com/psychiatry/dementia/93689
    Tariot PN, Cummings JL, Soto-Martin ME et al Trial of pimavanserin in dementia-related psychosis. N Engl J Med 2021; 385:309-319, July 22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34289275 https://www.nejm.org/doi/full/10.1056/NEJMoa2034634
    Friedman JI Pimavanserin in dementia-related psychosis. N Engl J Med 2021; 385:372-373. July 22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34289282 https://www.nejm.org/doi/full/10.1056/NEJMe2109010
  71. 71.0 71.1 Anderson P Cannabinoids 'Worth a Try' for Agitation in Alzheimer's Medscape - Feb 02, 2021. https://www.medscape.com/viewarticle/945163
    Outen JD, Burhanullah MH, Vandrey R et al Cannabinoids for Agitation in Alzheimer's Disease. Am J Geriatr Psychiatry 2021. Jan 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33573996 https://www.ajgponline.org/article/S1064-7481(21)00030-0/fulltext
  72. 72.0 72.1 Tumolo J Dementia-Related Psychosis Presents Significant Cost Burden Annals of Long-Term Care. June 22, 2021 https://www.hmpgloballearningnetwork.com/site/altc/news/dementia-related-psychosis-presents-significant-cost-burden
    Sangha K, Rashid N, Abler V, Rajagopalan K. Economic Burden of Dementia Related Psychosis Among Medicare Beneficiaries: A State-Transition Markov Analysis of Total Annual Direct Costs. CNS Spectr. 2021;26(2):161. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34127102
  73. 73.0 73.1 Long EM Case Report and Brief Review. The Effect of a Personalized Music Playlist on a Patient With Dementia and Evening Agitation. Annals of Long-Term Care. December 2016 https://www.hmpgloballearningnetwork.com/site/altc/article/effect-personalized-music-playlist-patient-dementia-and-evening-agitation
  74. 74.0 74.1 Banerjee S, High J, Stirling S et al Study of mirtazapine for agitated behaviours in dementia (SYMBAD): a randomised, double-blind, placebo-controlled trial. Lancet. 2021 398(10310):1487-1497. October 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34688369 PMCID: PMC8546216 Free PMC article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01210-1/fulltext#%20
  75. Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34688369 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/
  76. 76.0 76.1 Asimopoulos M Doll Therapy Reduced Dementia Symptoms, Caregiver Burden. Annals of Long-Term Care. November 12, 2021 https://www.hmpgloballearningnetwork.com/site/altc/news/doll-therapy-reduced-dementia-symptoms-caregiver-burden
    Santagata F, Massaia M, D'Amelio P The doll therapy as a first line treatment for behavioral and psychologic symptoms of dementia in nursing homes residents: a randomized, controlled study. BMC Geriatr. 2021 Oct 12;21(1):545 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34641791 PMCID: PMC8507228 Free PMC article
  77. Muhlbauer V, Mohler R, Dichter MN et al Antipsychotics for agitation and psychosis in people with Alzheimer's disease and vascular dementia. Cochrane Database of Systematic Reviews. December 17, 2021 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013304.pub2/full
  78. 78.0 78.1 78.2 78.3 Ismail Z, Creese B, Aarsland D et al Psychosis in Alzheimer disease - mechanisms, genetics and therapeutic opportunities. Nat Rev Neurol 2022. January 4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34983978 Review. https://www.nature.com/articles/s41582-021-00597-3
  79. 79.0 79.1 79.2 79.3 79.4 Watt JA, Thompson W, Marple R et al Managing neuropsychiatric symptoms in patients with dementia. BMJ 2022;376:e069187 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35078774 https://www.bmj.com/content/376/bmj-2021-069187
  80. 80.0 80.1 Warrington TP, Bostwick JM. Psychiatric adverse effects of corticosteroids. Mayo Clin Proc. 2006 Oct;81(10):1361-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17036562 Review.
  81. Rothenberg KG, Rajaram R. Advances in management of psychosis in neurodegenerative diseases. Curr Treat Options Neurol. 2019;21(1):3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30673880 Review. https://link.springer.com/article/10.1007/s11940-019-0545-6
  82. Fleisher AS, Truran D, Mai JT et al. Chronic divalproex sodium use and brain atrophy in Alzheimer disease. Neurology. 2011;77(13):1263-1271 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21917762 PMCID: PMC3179645 Free PMC article https://n.neurology.org/content/77/13/1263
  83. Sarycheva T, Lavikainen P, Taipale H et al. Antiepileptic drug use and mortality among community-dwelling persons with Alzheimer disease. Neurology. 2020;94(20):e2099-e2108 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32327491 PMCID: PMC7526675 Free PMC article https://n.neurology.org/content/94/20/e2099
  84. Taipale H, Gomm W, Broich K et al. Use of Antiepileptic Drugs and Dementia Risk-an Analysis of Finnish Health Register and German Health Insurance Data. J Am Geriatr Soc. 2018;66(6):1123-1129 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29566430 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.15358
  85. 85.0 85.1 DePeau-Wilson M FDA Advisors Endorse Rexulti for Agitation in Alzheimer's Dementia. Increased mortality risk seen but benefits may outweigh this, panelists say MedPage Today April 14, 2023 https://www.medpagetoday.com/psychiatry/dementia/104041
    US Food & Drug Administration News Release. May 11, 2023 FDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer's Disease. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease
  86. 86.0 86.1 86.2 NEJM Knowledge+ Question of the Week May 23, 2023 https://knowledgeplus.nejm.org/question-of-week/2143/
    van Dalen-Kok AH, Pieper MJ, de Waal MW, Lukas A, Husebo BS, Achterberg WP. BMC Geriatr. 2015 Apr 19;15:49. Association between pain, neuropsychiatric symptoms, and physical function in dementia: a systematic review and meta-analysis. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25928621 PMCID: PMC4409739 Free PMC article
    Lobbezoo F, Delwel S, Weijenberg RAF, Scherder EJA. Orofacial Pain and Mastication in Dementia. Curr Alzheimer Res. 2017;14(5):506-511 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28490315 Review
    Marchini L, Ettinger R, Caprio T, Jucan A. Oral health care for patients with Alzheimer's disease: An update. Spec Care Dentist. 2019 May;39(3):262-273. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30964560
  87. 87.0 87.1 Huang YY, Teng T, Giovane CD et al. Pharmacological treatment of neuropsychiatric symptoms of dementia: a network meta-analysis. Age Ageing. 2023 Jun 1;52(6):afad091 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37381843
  88. 88.0 88.1 88.2 d'Angremont E, Begemann MJH, van Laar T et al Cholinesterase Inhibitors for Treatment of Psychotic Symptoms in Alzheimer Disease and Parkinson Disease. A Meta-analysis. JAMA Neurol. 2023;80(8):813-823 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37358841 PMCID: PMC10294019 (available on 2024-06-26) https://jamanetwork.com/journals/jamaneurology/fullarticle/2806600
  89. 89.0 89.1 89.2 Luhnen J, Richter T, Calo S, et al. Psychosocial interventions for reducing antipsychotic medication in care home residents. Cochrane Database Syst Rev. 2023 Aug 31;8(8):CD008634. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37650479 PMCID: PMC10471006 (available on 2024-08-31) https://journalwise.acponline.org/Articles/SpecialtyAlert/110639
  90. 90.0 90.1 Ishimaru D, Tanaka H, Nagata Y, Ogawa Y, Fukuhara K, Nishikawa T. Aspects of Rest-Activity Rhythms Associated With Behavioral and Psychological Symptoms in Moderate and Severe Dementia, Results of a Cross-sectional Analysis. Alzheimer Dis Assoc Disord. 2023 Oct 13 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37824629 https://journals.lww.com/alzheimerjournal/abstract/9900/aspects_of_rest_activity_rhythms_associated_with.80.aspx
  91. 91.0 91.1 Lee D, Slomkowski M, Hefting N et al. Brexpiprazole for the Treatment of Agitation in Alzheimer Dementia: A Randomized Clinical Trial. JAMA Neurol. 2023 Nov 6:e233810. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37930669 PMCID: PMC10628834 Free PMC article
  92. 92.0 92.1 92.2 NEJM Knowledge+
  93. 93.0 93.1 Rane A et al Comparative Efficacy and Safety of Pharmacological Interventions in Patients with Dementia-Related Agitation or Aggression: A Network Meta-Analysis. Am J Geriatr Psychiatry 2024. 32(4):S95 Not yet indexed in PubMed https://www.sciencedirect.com/science/article/abs/pii/S106474812400188X
  94. 94.0 94.1 Putka S Alzheimer's Agitation Relapse Delayed With Dextromethorphan-Bupropion. Data suggest clinical response with few adverse effects for patients. MedPage Today April 17, 2024 https://www.medpagetoday.com/meetingcoverage/aan/109714
    Brooks M Novel Agent Curbs Alzheimer's-Related Agitation. Medscape. April 23, 2024 https://www.medscape.com/viewarticle/novel-agent-curbs-alzheimers-related-agitation-2024a10007ug

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psychosis, agitation & difficult behavior in the elderly patient information