Emerging Options & Clinical Considerations for [Specific Condition/Treatment Area]
New Hope for Managing Agitation in Alzheimer’s Disease: A Shifting Treatment Landscape
Table of Contents
Agitation is a common and distressing symptom experienced by approximately 50% of all patients with alzheimer’s disease (AD), frequently enough correlating with more severe cognitive and functional decline. For years, clinicians faced a critically important void in FDA-approved treatments for this challenging aspect of dementia care. Historically, available agents carried serious warnings, including potential increases in mortality and cerebrovascular adverse events, particularly with antipsychotic use in patients with dementia-related agitation. moreover, common pharmacologic approaches like SSRIs and benzodiazepines have demonstrated limited efficacy.
A Turning Point in Alzheimer’s Agitation Management
The treatment landscape for agitation associated with Alzheimer’s disease is undergoing a significant transformation. As highlighted by Dr. Maguire, director of residency training in psychiatry at College Medical Center in Long Beach, California, a new era of targeted therapies is emerging.
brexpiprazole: A New FDA-Approved Option
A pivotal growth in this field is the FDA approval of brexpiprazole (Rexulti) in 2023 for the treatment of agitation associated with dementia due to Alzheimer’s disease. Administered at a dosage of 2mg to 3mg per day, brexpiprazole offers a novel mechanism of action, influencing three key monoamine systems: noradrenergic, serotonin, and dopamine. This multi-system approach represents a significant advancement in addressing the complex neurobiology underlying agitation in AD.
Promising Future Avenues
Beyond brexpiprazole, additional therapeutic options are on the horizon.Dr. Maguire noted the promising results of AXS-05 (bupropion/dextromethorphan), which has shown positive outcomes in three out of four clinical trials, including the pivotal ADVANCE and ACCORD studies.These developments signal a growing arsenal of treatments to help manage agitation in AD patients.
The Crucial role of Non-Pharmacologic and Medical Evaluation
Despite the advent of new pharmacologic interventions, Dr. Maguire strongly emphasizes the paramount importance of a extensive evaluation before initiating any medication.He advises clinicians to first explore and address potential non-pharmacologic and underlying medical causes of agitation.
Identifying Triggers for Agitation
“Coudl there be something that’s leading to the agitation? Has a patient… had a change in habitat?” Dr. Maguire posed, underscoring the need to investigate environmental disruptions. Untreated pain, infections, or metabolic disturbances are also critical comorbid medical conditions that must be ruled out. “Before we go adding on another medicine, make sure that we certainly know medically what’s also going on for that patient,” he stressed.this holistic approach ensures that the root causes of agitation are addressed, potentially reducing the need for or optimizing the use of pharmacologic agents.
The Imperative of Timely Intervention
The significance of prompt and effective management of agitation in Alzheimer’s disease cannot be overstated.”We do know that agitation in and of itself leads to a poor prognostic outcome for patients with dementia,” Dr. Maguire stated.
Improving Quality of Life and Care Settings
Managing agitation effectively not only improves the quality of life for individuals with AD but also plays a crucial role in delaying transitions to more restrictive care settings.”The longer we can keep patients at home, surrounded with their family members, the better,” he concluded, highlighting the profound impact of well-managed agitation on patient well-being and family support.
References
- Maguire G. Managing Agitation in dementia. Presented at: The Southern Psychiatry Conference; July 11-12, 2025; Huntington Beach, California.
- FDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer’s Disease. Press release.May 11, 2023. accessed July 12, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease