The 2023 International Psychogeriatric Association (IPA) consensus definition of agitation in patients with cognitive disorders includes:6
Diagnosis of cognitive impairment or dementia syndrome:
Agitated behaviours and duration
• Patients must exhibit ≥1 agitation behaviour associated with emotional distress
• Behaviour must be persistent or frequently recurrent for ≥2 weeks or must represent a change from the patient’s usual behaviour
Severity of agitated behaviours
• Behaviour must be severe enough to produce excess distress or disability and significantly impair one of the following: interpersonal relationships, other aspects of social functioning, ability to perform or participate in daily living activities
Cause of agitated behaviours
• Agitation cannot be attributed solely to another psychiatric disorder, suboptimal care conditions, medical condition, or physiological effects of a substance
The IPA defines agitation in Alzheimer’s dementia as excessive motor activity (i.e., pacing, rocking, gesturing), verbal aggression (i.e., yelling, speaking in an excessively loud voice, using profanity), or physical aggression (i.e., grabbing, shoving, pushing).6
References:
1.Peters ME, Schwartz S, Han D, et al. Neuropsychiatric symptoms as predictors of progression to severe Alzheimer’s dementia and death: the Cache County Dementia Progression Study. Am J Psychiatry 2015; 172 (5): 460–465.
2.Banerjee S, Smith SC, Lamping DL, et al. Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. J Neurol Neurosurg Psychiatry 2006; 77 (2): 146–148.
3.Knapp M, Chua KC, Broadbent M, et al. Predictors of care home and hospital admissions and their costs for older people with Alzheimer’s disease: findings from a large London case register. BMJ Open 2016; 6 (11): e013591.
4.Borsje P, Wetzels RB, Lucassen PL, et al. The course of neuropsychiatric symptoms in community-dwelling patients with dementia: a systematic review. Int Psychogeriatr 2015; 27 (3): 385–405.
5.Selbæk G, Engedal K, Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc 2013; 14 (3): 161–169.
6.Sano M, Cummings J, Auer S, et al. Agitation in cognitive disorders: progress in the International Psychogeriatric Association consensus clinical and research definition. Int Psychogeriatr 2023: 1–13. doi: 10.1017/S1041610222001041
7.Carrarini C, Russo M, Dono F, et al. Agitation and dementia: prevention and treatment strategies in acute and chronic conditions. Front Neurol 2021; 12: 644317.
