This protocol applies to patients with Alzheimer's disease who are experiencing agitation and aggression — and in whom an initial structured course of non-pharmacological management has not been sufficient to resolve these symptoms.
Non-pharmacological interventions were applied first: reducing sources of stress and triggers, training carers in calm and non-threatening communication, addressing environmental noise, providing reassurance, and using regular non-opioid analgesia where pain was identified as a contributing factor.
The target for that line — resolution of agitation and aggression within 2 weeks — was not achieved. This protocol describes the next step.
When non-pharmacological management is not sufficient, this protocol moves to a pharmacological strategy. Cardiac safety evaluation is a required step before any agent is started. The specific choice of agent and the full clinical pathway are contained in the structured regimen.
Significant reduction in the frequency of episodes of agitation after 4 weeks.
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.
After the exclusion of active medical conditions and an ECG to check the QT corrected for heart rate interval, she is prescribed citalopram.
The frequency of episodes of agitation is significantly reduced after 4 weeks.
DOI: 10.1016/S0140-6736(25)01329-7
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