DeAnne Zwicker MS, APRN, BC
Dementia is usually known to exist prior to an older person entering the hospital. On the other hand, disruption of an older adult's normal routine may surface a previously undiagnosed dementia in the hospital.
In either situation, agitation and sometimes aggression are common and often emergent behavioral manifestations of the patient with dementia. These neuropsychiatric symptoms are also seen in patients with delirium, schizophrenia, and bipolar disorder in the presence or absence of dementia. These symptoms are not disease specific and derive from neurobiological changes in areas of the brain and are influenced by the patient's interaction with the environment.
It is not unusual for patients with dementia to also be delirious. Agitation thus may be a manifestation of dementia alone, or it may be caused or made worse by delirium. (See Delirium Topic)
Agitation: excessive motor or verbal activity.
|Table 1. Most Likely Causes of Agitation/Agression in Individuals with Dementia: Assessment and Interventions|
|Assess for unrelieved acute or chronic pain or discomfort
Consider superimposed medical condition such as infection, electrolyte disturbance, endocrine abnormality, or hypoxia.
Consider drug therapy or substance abuse
|Assess environmental stressors such as noise, overstimulation, understimulation, lack of structure/ predictability including during transitions in care to another setting||
|Assess for causal or contributing interpersonal communication factors that may trigger agitation such as communication deficits (vision/hearing), fear or anxiety, and caregiver's response to the patient's behavior||
|Recognize cues to escalating behaviors that lead to agitation and catastrophic reactions||The key to nonpharmacological intervention for episodes of agitation/aggression is to identify and avoid the triggers and contributing factors
If catastrophic behavior occurs:
Teri, L; Logston, R, McCurry, S. (2002). Nonpharmacological treatment of behavioral disturbance in dementia. Medical Clinics North America, 86, pp. 641-656.
Volicer, L, Hurley, A. (2003). Management of behavioral symptoms in progressive degenerative dementias. Journal of Gerontology: Medical Sciences,58A, pp. 837-845.
Allen, MH. (2000).Managing the agitated psychotic patient: a reappraisal of the evidence. Journal of Clinical Psychiatry, 61 (supplement 14), pp 11-20.
Allen, MH, Currier, GW, Hughes, DH, et al. (2001).The expert consensus guideline series: Treatment of behavioral emergencies.Postgraduate Medicine Special Report, pp. 1-88.
Last updated - March 2009