Patient-Specific Clinical Formulation for Agitation in Alzheimer's Disease: Beyond Group-Level Evidence

Agitation in Alzheimer's disease (AD) is clinically heterogeneous. Patients who meet the same syndromic definition can differ in the behaviour of greatest concern, the factors that precipitate or sustain it, the risks involved and their response to treatment. Randomised trials are essential for estimating average treatment effects; individual treatment selection also requires patient-specific clinical information. This review considers patient-specific clinical formulation as a practical way to connect group-level evidence with individual treatment decisions. The formulation makes explicit what is being treated, which contributors are plausible, which contextual or reversible factors matter, what outcome would count as meaningful improvement and when treatment should be changed or stopped. Treatment response then becomes additional clinical information: early benefit, adverse effects or an unexpected course may support or call into question the initial formulation. Non-pharmacological care and treatment of reversible causes remain the foundation of management, with medication reserved for agitation that is severe, persistent, dangerous or highly distressing. For Japan, we propose a formulation summary as a prototype for shared documentation across care settings; its feasibility and clinical value require prospective evaluation. Moving beyond group averages entails applying evidence more carefully to the needs of the individual patient.