Dementia Agitation Flashcards
What are medical causes of agitation in dementia?
- Medication
- Infection
- CVA
- Trauma
- Pain
What is the future of dementia agitation treatment?
Drugs targeting underlying neurobiological mechanisms
What does current treatment for dementia look like?
Using currently understood drugs to treat primary psychiatric conditions and symptoms
When do we evaluate for dementia and delirium?
Multiple cognitive deficits on cognitive exam after presenting with hallucinations and/or delusions
When do we diagnose mood disorder?
Mood symptoms predominate with hallucinations and/or delusions
When do we diagnose schizophrenia?
Mood symptoms are minimal with hallucinations and/or delusions. Mood disorder workup is negative.
When do we diagnose delusional disorder?
Mood symptoms are minimal and hallucinations are absent. Schizophrenia workup is negative.
T/F: Antipsychotics should be used in patients with dementia-related psychosis
FALSE: increased risk of death
T/F: Conventional antipsychotics have a higher risk of death than atypicals in dementia-related psychosis
TRUE
Which antipsychotic has the lowest risk of death?
Quetiapine (doesn’t mean it’s safe)
What are symptoms of dementia?
- Psychosis (hallucinations/delusions)
- Depressive symptoms
- Apathy
- Manic-like behaviors
- Agitation or aggression
- “Sundowning”
- Insomnia
What is non-pharm for dementia?
- Family and caregivers
- Structuring physical and psychosocial environment
- Supervision
- Scheduled toileting
- Little help as possible with ADLs
- Role-modeling
- Avoid debating, be calm
- Caregiver support groups
- Music during meals or bathing
- Walking or light exercise
- Simulate family presence (video/audio)
- Pet therapy
- Speak at comprehension level
- Bright light, “white” noise
Where can Alzheimer’s patient caregivers go to get help?
Alzheimer’s Association
Schizophrenia is generally diagnosed (younger/older)
Younger
How should distress in Parkinson’s be treated?
- Quetiapine or olanzapine
- Pimavanserin (Nuplazid)
How should we treat Lewy Body Dementia hallucinations?
Quetiapine
AVOID 1ST GENS!!!
What does Lewy Body Dementia look like?
Alzheimer’s with Parkinsonism
What is first-line treatment for depressive symptoms in AD?
SSRIs (not paroxetine)
What antidepressant can help with appetite and insomnia?
Mirtazapine (low dose)
What antidepressant can help with sedation?
Trazodone
How can we treat apathy in AD?
Methylphenidate, dextroamphetamine, modafinil
What can we use to treat manic symptoms in dementia?
- Valproic acid**
- Lithium
- Lamotrigine
- Carbamazepine
What is agitation?
Uneasiness or inner tension without excessive motor activity
What is aggression?
A behavioral expression of severe agitation with potential to cause harm to self or others
How should we first treat agitation or aggression?
- Avoid triggers if intermittent
- Exclude discomfort
- Behavior modification using positive reinforcement
What should you avoid doing in agitation/aggression?
Physical restraining
What first-line pharmacological options do we have for agitation?
- Aripiprazole, olanzapine, quetiapine, risperidone (psychosis)
- SSRI like citalopram (depression)
- Buspirone, trazodone (anxiety)
What second-line pharmacological options do we have for agitation?
- Carbamazepine
- Valproic acid*
- Olanzapine
What are options for sexual aggression?
- 2nd gen antipsychotic, divalproex
If no response, try conjugated equine estrogens or medroxyprogesterone
What are acute treatment options for sundowning?
Night-lights, check-ins
Trazodone, haloperidol, fluphenazine, 2nd gen antipsychotics
What are additional options for sundowning that are only for long-term?
Melatonin
acute treatment options
T/F: Quetiapine can be used for insomnia
FALSE: only if sundowning or hallucinations present
How do we treat insomnia?
- Avoid triggers (caffeine, fluid intake, light, activity)
- Trazodone
- Melatonin
- BZDs (short-term only)
- Mirtazapine
When can we use brexpiprazole?
Agitation in dementia due to Alzheimer’s
BBW for death in dementia-related psychosis
