Managing agitation and difficult behavior in dementia.

The dementias are associated with disruptions in cognition, function, and behavior. Before the advent of dementia-specific therapies, management of difficult behaviors was the primary ‘‘treatment’’ of demented persons. Problematic behavioral symptoms such as agitation, apathy, depression, anxiety, delusions, irritability, and disinhibition are highly prevalent during the course of dementia [1]. Agitation and difficult behaviors are important factors influencing a family’s decision to choose nursing home placement for their demented elder [2]. Agitation occurs in as many as 70% to 90% of demented elderly nursing home patients, perhaps 50% of whom become frankly aggressive [3]. The term ‘‘agitation’’ describes inappropriate verbal, vocal, or motor activity that does not result from need. The agitated behaviors do not serve the interest of the patient and adversely affect others’ efforts to help. Some behaviors are inherently inappropriate, whereas others may be inappropriate due to their intensity, frequency, or the context in which they are exhibited [4]. Increasingly, the term ‘‘behavioral and psychological symptoms of dementia’’ is used for clinical purposes to group the myriad agitated and difficult behaviors arising in demented patients [5].