Agitation in dementia: Evidence-based consensus recommendations

Area of Science:

• Gerontology
• Psychiatry
• Evidence-based practice

Background:

• Agitation is a significant behavioral symptom in dementia, increasing caregiver burden and healthcare costs.
• Psychotropic medications have limited efficacy and notable adverse effects, necessitating alternative strategies.

Purpose of the Study:

• To evaluate the effectiveness of person-centered approaches (PCAs) and non-pharmacological interventions for dementia-related agitation.
• To synthesize evidence on interventions and assess their quality using the GRADE framework.

Main Methods:

• Comprehensive literature search of systematic reviews, meta-analyses, and RCTs on PCAs and non-pharmacological interventions for agitation in dementia.
• Quality assessment and strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework.

Main Results:

• Moderate-quality evidence supports massage/touch therapy, individualized music therapy, tailored activities, and multicomponent interventions.
• Sensory-based approaches like aromatherapy and Snoezelen showed inconsistent or low-quality evidence.
• PCA implementation and need-driven assessments enhance intervention effectiveness and quality of life.

Conclusions:

• PCA-guided, multifaceted non-pharmacological interventions are the preferred approach for managing dementia agitation.
• Individualized strategies, preceded by systematic PCA assessments, yield the most significant benefits.
• Future research should focus on optimizing implementation through training, collaboration, and technology.