Mental Health Month: A Guide to Agitation in Alzheimer's Disease

Health Professional

When people with Alzheimer's have regular or severe periods of agitation it can put unbearable strain on already stressed family relationships. Agitation is very common in people with dementia. Sixty to 80 percent  of people with Alzheimer'swill experience it at some point in their illness. Although agitation can be seen at any stage of the disease, it is most common in the moderate stage and tends to decline as Alzheimer's moves into the severe stage.

Early treatment and appropriate medical backup is important. It reduces caregiver burden and can help make significant economic savings as it prevents early hospitalisation and placement in nursing and care homes.

What is Agitation?

The way in which agitation manifests itself is highly individual. The term is used to describe a variety of inappropriate verbal, vocal, and/or physical behaviors. It includes verbal or physical aggression, assault and/or abuse. Examples include; cursing, yelling, screaming, making insulting remarks, grabbing, kicking, hitting, spitting, biting, and destroying property. Also quite common  are disinhibited  forms of behaviour such as public masturbation, groping or fondling others, public nudity, taking off clothing, swearing and making obscene comments.

Agitation Causes and Triggers

Agitation can be the result of specific or several factors. Identifying situations or events  known to cause arousal  can help you make adjustments to arrangements in order to prevent or lessen the severity of agitation and its effects on others.

The major causes of agitation include:

  • Alzheimer's and the associated physical damage that is occurring in the brain.
  • Illnesses such as heart, liver and  kidney disease, chest and urine infections, breathing difficulties, malignancy.
  • Delirium.
  • Post operative states.
  • Pain and physical discomfort.
  • Medications.
  • Sleep problems.
  • Psychiatric illnesses. Agitation is associated with paranoid psychosis in about 35 to 50 percent  of cases
  • Stress. This can include social situations such as  visits, appointments and family celebrations. Procedures such as  nursing and caregiver procedures like washing, changing clothes, baths and showers or escorting the person to the bathroom.

Treatments for Agitation:** Get professional medical help**. They will diagnose and treat any

underlying illnesses or conditions. A team approach is often the most effective. The team may include doctors, nurses, psychologists, neuropsychologists, an occupational therapist and, most importantly, you, the caregiver.

Assess behavior to identify any triggers to the agitated behavior. A thorough  assessment of behaviors may help. Use the ABC approach-The ABC's of Managing Challenging Behavior in Alzheimer's Disease. Behavioral treatment approaches are often the most effective. Behavior plans can be  carried out by all caregivers involved with the person will Alzheimer's. Consistency is often the key to effective behavioural responses and changes.

Medications

Tranquilizing medications and mood stabilizing medications can be used for symptoms such as severe agitation and anxiety, violence, hostility, psychotic delusions, uncooperative, hostile or suspicious/paranoid behavior. The aims of tranquilizer treatment is to reduce or relieve symptoms but not impair consciousness.

When treatment approaches fail to work then the plan needs to be re-assessed and a new treatment plan implemented. Treatment approaches for agitation need to be targeted  to the individual. Go back to your healthcare providers as often as you need help or advice.

Make the Environment Safe

Remove objects that can be used as weapons for self harm, or to harm others, if that is appropriate. Do not clutter his or her room if pushing is a problem. Make sure you have a clear exit if things get tough. To diffuse the situation or in extreme case, to keep yourself safe it is sometimes best to leave the area. Call 911 if need be.

**Links to Caregivers Tips for Coping with Agitatio   **

Coping with Disinhibited and Inappropriate Sexual Behavior

Aggression in Alzheimer's Disease

Behavior Problems in Mid to Late Stage Alzheimer's

Behavior as an Expression of Unmet Need

Coping with Paranoid Behavior in Alzheimer's

Alzheimer's Communication: Take a Few Breaths