Treatment Guidelines Forged for Agitation in Dementia Patients, Common Cause of Institutionalization.

Expert Consensus Makes Recommendations for Care, Offers Help to Families and Caregiver

(From the AP wire services)

ORLANDO, Fla., May 18 /PRNewswire/ -- Physicians and families now have a tool to assist them in caring for the growing number of elderly persons who suffer from severe agitation, one of the most disturbing symptoms of Alzheimer's disease or other forms of dementia.

"The Expert Consensus Guidelines for the Treatment of Agitation in Older Persons with Dementia" -- developed under the direction of researchers at Columbia University, Cornell University Medical College, Duke University and New York University School of Medicine -- were presented for the first time today at a symposium at the American Society of Consultant Pharmacists (ASCP) Midyear Conference & Exhibition, "Geriatrics '98"

4 million diagnosed with dementia...

Already, more than 4 million Americans over the age of 65 have been diagnosed with dementia, of which Alzheimer's disease is the most common type.

For patients, their families and caregivers, some of the most troubling symptoms associated with dementia are caused by agitation -- disruptive and often harmful behaviors that may include yelling, biting and kicking. Agitation tends to become worse over time and is often the reason families feel compelled to place their loved ones in nursing homes.

However, these disturbances are treatable. Experts suggest that significant relief can be obtained with both environmental interventions -- including changes in daily routines and patients' physical settings -- and certain medications.

For example, new research has shown that at least one of the "atypical" antipsychotics -- originally developed to treat schizophrenia and other psychoses -- can be highly effective in managing specific types of agitation, and is recommended as first-line treatment for these symptoms.

Other medications, including antianxiety and antidepressant agents, are also effective treatments for certain aspects of agitation in elderly patients with dementia.

"These guidelines extend beyond the research literature because they are based on the real-world experiences of leading geriatric experts in areas that have been difficult to study in clinical trials," explains David A. Kahn, MD, associate clinical professor of psychiatry at Columbia University and a member of the guidelines steering committee. "The result is the equivalent of an expert consultation with some of the top opinion leaders in geriatric care."

Guidelines...

The Expert Consensus Guidelines are the result of in-depth survey responses from 84 of the country's leading researchers and practitioners in the field of geriatric care. The experts were identified from recent research publications and funded grants, the Task Force for the American Psychiatric Association's "Practice Guidelines for the Treatment of Patients with Alzheimer's Disease and Other Disorders of Late Life," and those who have worked on other dementia guidelines.

The experts were polled on the treatment of the various causes and symptoms of agitation -- such as psychosis, aggression, depression and insomnia -- in 33 different clinical situations. Their responses were then analyzed and summarized, including recommendations for the use of specific medications and environmental interventions for different patient types and symptoms. The guidelines also provide a more precise method for assessing agitation in elderly patients with dementia. The underlying cause of agitation must be identified before specific treatments are selected.

Also offered is a separate consumer guide for patients and their families, which discusses treatment options in lay terms and describes strategies for coping with behavioral problems associated with agitation in dementia. The consumer guide was developed with input from experts at the American Association of Retired Persons (AARP), the American Federation for Aging Research (AFAR) and other leading groups.

"When most people think about Alzheimer's disease, they think of learning and memory problems -- not behavioral disturbances such as agitation," notes John P. Docherty, MD, professor of psychiatry at Cornell University Medical College. "As a result, there is currently very little information available that directly addresses these symptoms and what we currently know about the most effective ways to manage them. Patients, families, and their physicians must guess and experiment. These guidelines fill that gap."

Published as a supplement to the April issue of "Postgraduate Medicine," the guidelines can be accessed on the Expert Knowledge Systems (EKS) website at http://www.psychguides.com.

Preparation of the guidelines was supported by unrestricted educational grants from Janssen Pharmaceutica, Bristol-Myers Squibb Company (NYSE: BMY) and Abbott Laboratories (NYSE: ABT).

In addition, the patient and family guide will be made available to consumers early this summer through the American Federation for Aging Research (AFAR).

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