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Introduction
A number of behavioral problems may be associated with Alzheimers
disease. The word agitation is often used as an umbrella
term to describe these behaviors. As Alzheimers progresses,
most people with the disease experience agitation in addition
to memory loss and other thinking problems.
Overview on agitation
In the early stages of the disease, people with Alzheimers
may experience personality changes such as irritability, anxiety,
or depression. As the disease progresses, other symptoms may
occur, including sleep disturbances, delusions (firmly held
belief in things that are not real), hallucinations (seeing,
hearing, or feeling things that are not there), pacing, constant
movement or restlessness, checking and rechecking door locks
or appliances, tearing tissues, general emotional distress,
and uncharacteristic cursing or threatening language.
Agitation may be caused by a number of different medical
conditions and drug interactions or by any circumstances that
worsen the persons ability to think. Situations that
may lead to agitated behavior include moving to a new residence
or nursing home, other changes in the environment or caregiver
arrangements, misperceived threats, or fear and fatigue resulting
from trying to make sense out of a confusing world.
Agitated behavior can be disruptive and painful to both the
person with the disease and the caregiver. Agitation may interfere
with the ability of the person with the disease to carry out
the activities of daily living, and it may increase the risk
of harm to the affected individual and others. Caregivers
may be frightened, upset, or simply exhausted by the demands
of caring for a person who is agitated.
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Medical evaluation for agitation
A person exhibiting agitated behavior should receive a thorough
medical evaluation, especially when agitation comes on suddenly.
The treatment of agitation depends on a careful diagnosis,
determination of the possible causes, and the types of agitated
behavior the person is experiencing. With proper treatment
and intervention, significant reduction or stabilization of
the symptoms can often be achieved.
The symptoms of agitation often reflect an underlying infection
or medical illness. For example, the pain or discomfort caused
by pneumonia or a urinary tract infection can result in agitation.
An untreated ear or sinus infection can cause dizziness and
pain that affects behaviors. In some cases, prescription medication
can cause agitation. This is most likely to occur when multiple
medications are used, and the medications interact. Uncorrected
visual or hearing loss may also lead to agitated behaviors.
Treating the underlying medical condition may lessen the agitation.
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Behavioral interventions for agitation
There are two distinct types of treatments for agitation:
behavioral interventions and prescription medications. Behavioral
interventions should be tried first. In general, steps to
managing agitation include (1) identifying the behavior, (2)
understanding its cause, and (3) adapting the caregiving environment
to remedy the situation.
Correctly identifying what has triggered agitated behavior
can often help in selecting the best behavioral intervention.
Often the trigger is some sort of change in the persons
environment:
A key principle of intervention is redirecting the affected
individuals attention, rather than arguing, disagreeing,
or being confrontational with the person. Additional intervention
strategies include the following:
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simplifying the environment
-
simplifying tasks and routines
-
allowing adequate rest between stimulating events
-
using labels to cue or remind the person
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equipping doors and gates with safety locks
-
removing guns
-
using lighting to reduce confusion and restlessness at
night
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Medications to treat agitation
Medications can be effective in the management of some symptoms
of agitation, but they must be used carefully and are most
effective when combined with behavioral or environmental changes.
Medications should target specific symptoms so that improvement
can be monitored. People with Alzheimers disease are
susceptible to side effects that require close observation.
In general, it is best to begin treatment with a single medication
and with low doses.
Related resources
See Symptom
Management.
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