Pharmacotherapy of agitation in dementia

Abstract

Although we tend to focus on the cognitive issues ,the behavior of individuals with dementia is often the main problem that leads to institutionalization. Clinical guidelines recommend nonpharmacological approaches as the first choice in the treatment of behavioral and psychological symptoms [1]. Acetylcholinesterase inhibitors (AChEI) are the first-line pharmacological option ,but challenging risky behaviors may persist despite their use. Antipsychotics are indicated in such cases, but there is very limited evidence to support the efficacy and safety of these medications for managing agitation in dementia[2]. Antipsychotics are prescribed most often for this indication and, at the same time, are related to the highest risk of adverse effects and increased mortality. Compared with the common population, lower doses should be used and titrated gradually. When choosing the medication, pharmacokinetic and pharmacodynamic interaction with AChEI and memantine used by majority of patients with dementia should be considered [3][4].