Agitation Severity and Psychotropic Prescription in Acute Patients With Delirium Superimposed on Dementia

We aimed to compare agitation severity in dementia with versus without delirium (DSD vs. DwD); to identify clinical factors linked to agitation severity; and to examine psychotropic prescribing patterns, including clinical correlates.

We retrospectively analysed 1709 consecutive patients with dementia admitted to acute geriatric units, comparing those with and without delirium. Delirium and dementia were identified from discharge diagnoses documents. Agitation severity was assessed with the Pittsburgh Agitation Scale (PAS) during the first 72 h. Functional status at admission was documented according to the Functional Independence Measure (FIM). Psychotropic exposure included antipsychotics and benzodiazepines. Multivariable linear regressions examined associations between psychotropics and PAS; logistic regressions identified predictors of psychotropic prescribing.

DSD occurred in 680 patients (39.8%). Compared with dementia alone, DSD was associated with higher PAS scores (5.3 vs. 4.0, p < 0.001), poorer functional status (FIM 48.6 vs. 57.8, p < 0.001) and more frequent in-hospital falls (29.9% vs. 17.5%, p < 0.001). Psychotropic use was common in both groups but more prevalent in DSD group (73.5% vs. 56.0%, p < 0.001), whereas treatment intensity was similar between the two groups. In regression models, psychotropic exposure was associated with higher PAS scores (β = 2.48, 95% CI 1.63-3.34), with haloperidol, quetiapine, lorazepam and alprazolam independently associated with greater agitation. Logistic models showed that delirium, in-hospital falls and hypoxia significantly increased the likelihood of psychotropic prescribing, while Parkinsonism markedly reduced antipsychotic use.

DSD was linked to more severe agitation and psychotropic use. These findings support PAS-based monitoring and development of DSD-specific interventions prioritising non-pharmacological strategies.