A US-based practitioner’s guide to diagnosis, evaluation, and evidence-based treatment of agitation in Alzheimer’s dementia – recommendations of an expert, multispecialty advisory panel

Agitation in Alzheimer’s dementia has a substantial impact on patients, caregivers/family, and healthcare systems. As new evidence surrounding the treatment of agitation emerges, a roundtable of multispecialty experts convened to review published literature (from a PubMed database search on 1 October 2024) and provide evidence-based clinical practice consensus recommendations for the diagnosis and management of agitation in Alzheimer’s dementia for US-based primary care providers. The main objective of this article is to summarize key recommendations from the roundtable on identification, differential diagnosis, current clinical practice, nonpharmacologic interventions, pharmacologic interventions, and treatment and communication considerations for residential care facilities/home care settings and caregivers. Active communication between healthcare providers, patients, and caregivers/family is critical for early recognition, accurate diagnosis, and appropriate management and prevention of agitation. The foundation of treatment always begins with individualized psychoeducation and nonpharmacologic interventions based on the patient’s personality, interests, and level of functioning. Pharmacologic interventions are strongly considered when agitated behaviors become highly intense, disturbing, and disruptive or if major safety concerns cannot be otherwise addressed, and only when the healthcare provider is confident that the agitation can be sufficiently managed or mitigated with a pharmacologic intervention possessing a favorable individual risk-benefit profile. While several pharmacologic agents have been studied in high-quality clinical trials for the treatment of agitation in Alzheimer’s dementia, brexpiprazole is the only US Food and Drug Administration – approved treatment and it can be prescribed if warranted. Interventions should be continuously evaluated to optimize treatment and monitor and minimize potential side effects. A patient-centered approach that includes a strong partnership with caregivers/family as a vital part of the patient’s larger care team is encouraged. Following these recommendations for timely detection, accurate diagnosis, and appropriate management of agitation in patients with Alzheimer’s dementia is likely to improve outcomes for most patients and caregivers.