Welcome to ReachMD. On this episode, sponsored by Otsuka and Lundbeck, we’re joined by Dr. Clay Jackson, Clinical Assistant Professor of Family Medicine and Psychiatry at The University of Tennessee. Dr. Jackson is here to help us better understand agitation in Alzheimer’s dementia. Let’s hear from him now.
Hi, I want to begin by level-setting our understanding of Alzheimer's dementia.
So, an estimated 6.5 million adults aged 65 and older are living with Alzheimer's dementia in the United States as of 2022. And this number is expected to increase to 12.7 million by 2050.
So typically, we associate Alzheimer's dementia with neuropsychiatric symptoms like memory loss and cognitive decline. But that cognitive decline can also be associated with behavioral and emotional changes, such as agitation. In fact, you see a high prevalence of agitation in Alzheimer's Dementia, or AAD for short, across several patient settings and ranges of disease severity. And in both the community and long-term care settings, retrospective chart reviews have shown behaviors that align with elements of agitation as defined by the International Psychogeriatric Association, also known as the IPA. We’ll get to that just a bit later.
But for now, there are two key points for us to remember. First, agitation is very common in dementia. About half of patients are estimated to exhibit agitation.
Secondly, the prevalence of this condition is quite similar in both long-term care facilities and community settings.
For example, in one study, 53% of nursing home residents showed signs of AAD, and 45% of community-dwelling patients showed signs of it as well.
Specifically, across disease severity, in a two-year observation period, we see that the prevalence of agitation was about 56% in mild Alzheimer's cases, almost 75% in moderate to severe cases, and about 68% in severe cases.
In 2015, the International Psychogeriatric Association, or IPA, formed an Agitation Definition Working Group, ADWG, to develop a provisional consensus definition of agitation in patients with cognitive disorders.
Now, I see this as an educational opportunity for us medical professionals to really understand what agitation in Alzheimer's dementia is all about.
The IPA’s definition of agitation follows four criteria, including cognitive impairment, or dementia syndrome, agitation behavior and duration, agitation behavior severity, and agitation behavior cause. Part of this definition that speaks specifically to behaviors includes excessive motor activity, verbal aggression, and physical aggression.
So excessive motor activity in particular, can include pacing, rocking, restlessness, and performing repetitious actions.
Verbal aggression could present as yelling or profanity, as opposed to physical aggression, which can look like grabbing, shoving, or hitting others.
Unfortunately, we don't really have a gold standard rating scale or assessment tool to use in our everyday clinical care. But we do have validated rating scales that have been used in research studies of this patient population.
For example, The Cohen-Mansfield Agitation Inventory, or CMAI for short, helps quantify the frequency of agitated behaviors over the previous two weeks using a 7-point Likert scale from never to several times an hour.
Now obviously, these agitation behaviors can be distressing for patients, but they also represent a great deal of concern and stress for caregivers as well. In my opinion, the first step is to better understand the definition of agitation, and how agitation can be assessed, so we can better recognize the patients in our practices who are suffering from AAD and so we can recognize these behaviors early on. Then we can utilize the data coming from clinical trials to clarify appreciation of this illness and how to treat it.
To improve standards of care and quality of life for everyone involved, we need to be more aware of agitation in Alzheimer's dementia and recognize the behaviors early on.
Be sure to join us for our next sessions as we dig deeper into the pathophysiology and treatment guidelines for agitation in Alzheimer's dementia.
This program was sponsored by Otsuka and Lundbeck. If you missed any part of this discussion, visit ReachMD.com/IndustryFeature. This is ReachMD. Be Part of the Knowledge.
- Alzheimer’s Association. 2022 Alzheimer’s Disease Facts and Figures. Alzheimers Dement. 2022;18. doi:10.1002/alz.12638. Available at: https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf. Accessed April 14, 2022.
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- Fillit H, Aigbogun MS, Gagnon-Sanschagrin P, et al. Impact of agitation in long-term care residents with dementia in the United States. Int J Geriatr Psychiatry. 2021;36(12):1959-1969. doi:10.1002/gps.5604
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- Cummings J, Mintzer J, Brodaty H, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015;27(1):7-17. doi:10.1017/S1041610214001963
- Cohen-Mansfield J. Instruction manual for the Cohen-Mansfield agitation inventory (CMAI). Maryland: Research Institute of the Hebrew Home of Greater Washington; 1991.
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