Journal
JOURNAL OF PSYCHOPHARMACOLOGY
Volume 32, Issue 5, Pages 509-523Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0269881117744996
Keywords
Dementia; agitation; drug treatment; algorithm
Funding
- Centre for Addiction and Mental Health (CAMH)/University of Toronto
- National Institute for Health Research (NIHR) (UK)
- Canadian Centre for Ageing and Brain Health Innovation
- Canadian Consortium for Neurodegeneration in Aging (CCNA)
- Medical-Psychiatry Alliance
- Canadian Institutes of Health Research (CIHR)
- CIHR
- Ontario Mental Health Foundation
- CAMH
- US NIH
- Consejo Nacional de Ciencia y Tecnologia
- Instituto de Ciencia y Tecnologia del DF
- Brain and Behavior Research Foundation
- Ontario Ministry of Health and Long-Term Care
- Ontario Ministry of Research and Innovation Early Research Award
- W. Garfield Weston Foundation and Brain Canada
- Brain and Behavior Foundation, USA, Brain Canada
- Weston Brain Institute
- Ontario Brain Institute
- Canadian Centre for Ageing and Brain Health Innovation and CCNA
- American Psychiatric Association
- CAMH Foundation
- Ontario Ministry of Research and Innovation
- W. Garfield Weston Foundation
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Introduction: Behavioural and psychological symptoms of dementia (BPSD) include agitation and aggression in people with dementia. BPSD is common on inpatient psychogeriatric units and may prevent individuals from living at home or in residential/nursing home settings. Several drugs and non-pharmacological treatments have been shown to be effective in reducing behavioural and psychological symptoms of dementia. Algorithmic treatment may address the challenge of synthesizing this evidence-based knowledge. Methods: A multidisciplinary team created evidence-based algorithms for the treatment of behavioural and psychological symptoms of dementia. We present drug treatment algorithms for agitation and aggression associated with Alzheimer's and mixed Alzheimer's/vascular dementia. Drugs were appraised by psychiatrists based on strength of evidence of efficacy, time to onset of clinical effect, tolerability, ease of use, and efficacy for indications other than behavioural and psychological symptoms of dementia. Results: After baseline assessment and discontinuation of potentially exacerbating medications, sequential trials are recommended with risperidone, aripiprazole or quetiapine, carbamazepine, citalopram, gabapentin, and prazosin. Titration schedules are proposed, with adjustments for frailty. Additional guidance is given on use of electroconvulsive therapy, optimization of existing cholinesterase inhibitors/memantine, and use of pro re nata medications. Conclusion: This algorithm-based approach for drug treatment of agitation/aggression in Alzheimer's/mixed dementia has been implemented in several Canadian Hospital Inpatient Units. Impact should be assessed in future research.
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