Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition

Abstract

Background:Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs.Methods:The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process.Results:Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as “strongly agree” or “somewhat agree” (68–88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications.Conclusions:A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.

Narrativity and Memory Analysis in Alzheimer’s Disease

“…Memory dysfunction also interferes with language possibilities [21]. Knowing the importance of both these components could help to prepare as well as possible for the consequences on the patient's social life [22] [23] [24].…”

“…The inability for a patient to express his or her own suffering [35] faced by a world that escapes his or her consciousness is a source of suffering both for the patient and his family [36] [37] [38]. Understanding language mechanisms is thus contingent to understanding the meaning of symptoms expressed by the patient's behaviour [22] [37] [39]. Language dysfunction, communication distortion, and mutual incomprehension are part of the hidden causes that sometimes lead formal or informal (family) care-givers into painful situations [40] [41]: psychological or psychiatric difficulties in the families, unspoken discord, financial problems arising from errors made by the aging patient as well, unfortunately, as the tactlessness or unscrupulousness of some people… What is at stake here is important as usual [42], and consequently we have tried, in this monocentric prospective observation and study to evaluate semantic and textual dysfunction in AD.…”

A preclinical screen to evaluate pharmacotherapies for the treatment of agitation in dementia

“…Agitation has been defined as inappropriate verbal, vocal or motor activity that is unexplained by apparent needs or confusion (Cohen-Mansfield and Billig, 1986). While agitation might include aggressive behaviors, it can occur without aggression (Cummings et al, 2015), and when it is severe it requires pharmacological treatment (Herrmann and Lanctot, 2007). The treatment of agitation has been identified as an unmet need in relation to adequate care provided for those suffering from cognitive impairments (Gitlin et al, 2012;Herrmann and Lanctot, 2007).…”

“…The treatment of agitation has been identified as an unmet need in relation to adequate care provided for those suffering from cognitive impairments (Gitlin et al, 2012;Herrmann and Lanctot, 2007). When the agitation is severe the symptoms include disinhibition, irritability, aggression and aberrant motor activity, which affect the patient's quality of life and cause increased stress for the family and caregivers (Antonsdottir et al, 2015;Cummings et al, 2015;Panza et al, 2015;Kales et al, 2014).…”

“…Agitation related to dementia is frequently observed clinically (Cohen-Mansfield, 2013;Ballard et al, 2001;Lyketsos et al, 2000), and various pharmacological interventions have been employed to treat this. These treatments include the use of anxiolytic, antidepressant, antipsychotic and anticonvulsant drugs (Antonsdottir et al, 2015;Cummings et al, 2015;Panza et al, 2015;Soto et al, 2015;Kales et al, 2014;Salzman et al, 2008). The most contentious approach relates to the use of antipsychotic drugs , which have been reported to be of only modest value (Ballard et al, 2009;, and to produce adverse effects (Gitlin et al, 2012).…”