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This issue of Insights & Implications in Gerontology provides an overview of agitation in Alzheimer’s disease (AAD) and outlines a process for assessing and treating the condition with a focus on collaborating with caregivers and, to the extent possible, individuals with AAD. It also shares implications from appropriate interdisciplinary care and how the lack of such care can be detrimental to individuals with AAD, their caregivers, and family members. AAD can occur along the entire spectrum of Alzheimer’s disease, but it is reported at higher rates in those with more severe dementia. It is also associated with many negative outcomes, including accelerated disease progression, physical and mental health deterioration, functional decline, and poor quality of life. This publication illustrates how proper treatment (from assessment to non-pharmacologic interventions and, if needed, pharmacologic treatment) can reduce the symptoms of agitation. 

Support provided by Otsuka.

This infographic highlights key information from the publication, Insights & Implications in Gerontology: Agitation in Alzheimer's Disease. 

Support provided by Otsuka.

Agitation in Alzheimer's Disease (AAD) impacts nearly 80% of persons with Alzheimer's Disease and is a cause of significant distress for patients and family/professional caregivers. The Agitation in Alzheimer’s Disease Decision Tree walks the clinician through a range of non-pharmacologic treatment options and highlights rational use of pharmacotherapies as well as their hazards in this vulnerable population. Informed by an expert panel, GSA developed the Agitation in Alzheimer’s Disease Decision Tree that was presented as a poster at the GSA Annual Scientific Meeting in November 2022 and recently updated to reflect the final International Psychogeriatric Association consensus clinical and research definition of agitation in cognitive disorders. 

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Most individuals with dementia experience behavioral symptoms during their disease trajectory. These symptoms are troubling to the person living with dementia, their care partners, and others such as family members or those living in congregate living settings. In this Momentum Discussion Podcast episode, Dr. Kalisha Bonds Johnson, a Board-Certified Psychiatric-Mental Health Nurse Practitioner at Emory Integrated Memory Care, shares her insights into the importance of detecting and addressing behavioral symptoms. She offers general strategies that care partners and others can take when interacting with someone with dementia, and she provides important insights into managing specific troubling behaviors.

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This podcast episode is supported by Eisai, Genentech, Lilly, and Otsuka.

In this Momentum Discussion podcast episode, interprofessional experts from Emory Integrated Memory Care discuss the common neuropsychiatric condition of agitation in Alzheimer's disease (AAD) and how it impacts individuals living with Alzheimer's and their caregivers. They discuss challenges to detecting AAD and share how detecting and treating this common symptom can improve quality of life for older adults and their caregivers. Finally, they discuss the Agitation in Alzheimer’s Screener for Caregivers (AASC^TM), a new tool released during the 2023 GSA Annual Scientific Meeting, with which clinicians can screen for AAD in just one minute. More information about the AASC^TM is available online at theaasc.com.

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For more information on speakers of this session, visit podbean for details.

This podcast episode is supported by Otsuka. 

Agitation can be described as increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. It may include nonaggressive behaviors such as pacing, repetitious movements, and general restlessness, or it may manifest as physically or verbally aggressive behaviors. It is one of the most distressing behavioral and psychological symptoms of dementia, and between 30% and 80% of people living with dementia, depending on the setting, experience agitation. Because of the wide-ranging potential negative impacts associated with agitation in Alzheimer’s disease (AAD), a person-centered, individualized approach to address AAD is a must. In this Momentum Discussion Podcast episode, we provide insights into AAD from the perspective of a professional caregiver and a family member whose loved one lives with AAD. They share how the condition impacts the person with Alzheimer’s disease and those around them and offer strategies to prevent and address troubling behavioral and psychological symptoms of dementia associated with AAD. 

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For more information on speakers of this session, visit podbean for details.

This podcast episode is supported by Otsuka. Content was developed by Gerontological Society of America (GSA).

GSA’s February 2021 white paper identifies challenges that persons with dementia-related psychosis and their caregivers encounter as they move through different health care settings. The challenges and strategies to address them are based on input from experts in primary care, neurology, geriatric psychiatry, and nursing. Proposed strategies include improving communication about dementia-related psychosis with persons with dementia and their families, developing new educational initiatives to support primary care teams, and enhancing approaches to care coordination among primary and specialty care through telehealth and new models of care. 

This white paper was developed through an unrestricted grant from Acadia Pharmaceuticals, Inc.

GSA’s August 2019 report brings attention to the need for greater awareness of dementia-related psychosis within the medical community and better support for those affected. Currently, there is no consensus in the medical community on how to diagnose dementia-related psychosis, which is clinically distinct from psychosis in other disorders (e.g., schizophrenia). Documentation and coding of the condition are also not standardized, making it difficult to identify, monitor and appropriately manage symptoms. This publication seeks to fill a gap in the available literature by summarizing best practices for treating dementia-related psychosis and proposing improvements to advance quality of care. 

This report was developed through an unrestricted grant from ACADIA Pharmaceuticals.

It is estimated that over 2 million Americans with dementia experience delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). This group of symptoms, known as dementia-related psychosis, may cause significant distress to individuals and their families. Although common, the condition frequently goes undetected in people who may be struggling with other complex behavioral and psychological symptoms of dementia. 

Support provided by Acadia.

Dementia-related psychosis, defined as hallucinations and delusions in individuals with dementia, is a distinct neuropsychiatric symptom. Dementia-related psychosis differs from psychosis that originates from delirium or a pre-existing psychotic disorder (e.g., schizophrenia). Dr. Gary Small explains the challenges to and approaches for detecting and diagnosing these symptoms. 

Primary care providers (PCPs) are ideally positioned to recognize, diagnose, and provide care planning for individuals with dementia who experience psychosis. Dr. Alexis Eastman discusses the important role of PCPs in team-based approaches to care and shares examples of innovative healthcare delivery models that can support PCPs in addressing dementia-related psychosis.

Individuals with dementia-related psychosis experience worse outcomes than those who do not have psychosis, including but not being limited to accelerated time to being admitted to a long-term care facility and accelerated mortality. The manifestation of hallucinations and delusions in residents with dementia can also prove challenging for long-term care staff. Dr. Chad Worz discusses how appropriate documentation of a diagnosis of dementia-related psychosis and related care interventions are an important part of delivering individualized care for residents.