What is your approach to addressing dementia-related agitation for patients living at home with family?

There is absolutely no simple way to answer that question. Even when the family is providing a very calm and nonconfrontational environment, avoiding any possible way of causing the agitation, it is virtually impossible to predict when and why a person with dementia would become agitated, angry, unp...

I would recommend first deciding if the agitation is emergent, urgent, or non-urgent. My definition for these three situations is: Emergent means if nothing is done, the patient will need to be hospitalized within the day. Urgent usually means you might have a bit less than 1 week to make a change b...

We’ve got to use more low-dose lithium for these patients. It’s a natural and very well-tolerated substance with a lot of evidence in reducing impulsivity and agitation, including independent evidence of a prophylactic effect against worsening of cognitive decline. Unfortunately, too many providers ...

The American Geropsych recommended a small dose of trazodone as a first-line agent to manage agitation in dementia due to the lack of black box warnings in patients with dementia. Antipsychotics would be the next line of treatment and is the most commonly used class of medication for managing agitat...

Brexipiprazole...I know it is expensive, possibly no different than aripiprazole, etc., but it is FDA-approved.

Otherwise agree with trazodone, low dose of lithium is interesting, so long as we aren't worried about UTIs, etc., I tend to add an SSRI initially to see if it has any benefit.

Lee et al., ...

Agitation is too broad a term to be meaningful. We must specify the type and severity of symptoms, which helps direct medication options. For example, highly delusional and physically aggressive would likely require an antipsychotic; restlessness would be best treated with low-dose escitalopram or s...

Now there is Auvelity for this with no black box warning for the elderly. They have a titration pack where it starts off with lower DXM and then gradually increases to the normal dosing. I’ve only used it once for that and it worked for agitation, but the side effect was dizziness, which was seen in...