Clinical Scenario

This protocol addresses patients with Alzheimer's disease who present with agitation and aggression — behavioural symptoms that require a structured, evidence-based first-line response.

Key Condition: Agitation

Agitation and aggression in Alzheimer's disease represent a distinct therapeutic challenge. The approach begins by identifying and addressing the underlying sources of stress and specific triggers driving these behaviours.

First-Line Approach (Partial)

The first-line strategy centres on non-pharmacological interventions aimed at reducing known stressors and triggers — the complete sequence of steps, including additional options where relevant, is detailed in the full protocol.

Full regimen, decision criteria, and further management options are available via the structured protocol below.

References

DOI: 10.1016/S0140-6736(25)01329-7

Only the atypical antipsychotics risperidone (Europe and Canada) and brexpiprazole (USA, Canada, and Switzerland), and the typical antipsychotic haloperidol (Germany), are licensed for the treatment of agitation aggression for people with dementia.
The first-line interventions should be aimed at reducing the source of stress (eg, treating chronic pain, teaching carers adaptive patient management behaviours, reducing sedative and anti-cholinergic medications, reducing environmental noise, or providing reassurance).
After exclusion of other active medical conditions, regular analgesia is prescribed and staff are trained to develop a non-threatening communication pattern, using soft tones and calming, non-verbal behaviour, and to take more time during interactions.
The best evidence on the pharmacological treatment of BPSD is for the treatment of agitation with non-opioid analgesics (effect size 0·48) and with the serotonin reuptake inhibitor citalopram (effect size 0·3).
Agitation and aggression resolved within 2 weeks.

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Treatment of Alzheimer's Disease with Agitation and Aggression

References