Taiwanese expert consensus on the assessment and management of agitation in dementia: A modified Delphi study

Agitation in dementia is clinically heterogeneous and requires individualized assessment, nonpharmacological strategies, and cautious pharmacological treatment. However, evidence-based consensus guidance addressing the broader care process across different care settings remains limited.

This two-round modified Delphi study was jointly conducted by the Taiwanese Society for Geriatric Psychiatry and the Taiwan Dementia Society. A working group developed preliminary statements based on targeted evidence review, statement-level evidence assessment, and clinical relevance to Taiwan. A panel of 30 experts, including 20 geriatric psychiatrists and 10 neurologists, participated in structured discussion, anonymous prioritization voting, post-round revision, and final anonymous voting. Consensus thresholds were predefined for evidence-based recommendations and good practice statements (GPS).

Of 14 preliminary statements generated by the working group, 10 were retained and organized into three clinical domains: diagnosis and assessment, nonpharmacological management, and pharmacological management by the panel. Four statements were classified as GPS, and six were evidence-based recommendations. Two statements received strong recommendations and four received conditional recommendations. All final statements met predefined consensus thresholds, with agreement ranging from 71% to 100%; eight statements achieved agreement of 90% or higher. The consensus supports structured assessment, identification of contributing factors, nonpharmacological and community-based care when feasible, pharmacological treatment only in clinically appropriate situations, and low-dose, short-term medication use with regular reassessment.

The consensus provides a practice-oriented framework for the assessment and management of agitation in dementia within the Taiwanese healthcare context. It may support stepwise clinical decision-making while identifying areas requiring further agitation-specific evidence.