Management of Aggression in Dementia

Non-Pharmacological Interventions

The American Psychiatric Association recommends assessing the effectiveness of non-pharmacological interventions before prescribing any antipsychotic medication, including evaluating the patient's environment and social interactions 1, 2
Structured activities, calming measures, socialization, and support for family and caregivers should be applied to manage aggression in dementia patients 3

The American Psychiatric Association suggests that antipsychotic medications should only be used in dementia patients with severe, dangerous, or distressing symptoms 1
When antipsychotics are necessary, the treatment should start with the minimum dose and gradually titrate to the minimum effective dose 4
If there is no clinically significant response after a 4-week course of adequate dosing, the antipsychotic medication should be gradually discontinued 5

For medication treatment of aggression in dementia, consider:
- Risperidone in low doses (0.25 mg/day, maximum 2-3 mg/day) 6
- Olanzapine (Zyprexa) in low doses (2.5 mg/day, maximum 10 mg/day), with caution and understanding of risks 6
- Trazodone (25 mg/day, maximum 200-400 mg/day) as an alternative to antipsychotics 6

Evaluate the type, frequency, severity, character, and timing of aggressive symptoms, and exclude pain and other modifiable factors contributing to aggression 1
Apply non-pharmacological methods of treatment, and if ineffective, consider other treatment options with a more favorable safety profile 6, 1
Regularly assess treatment effectiveness using quantitative measures 1

Any use of antipsychotics in dementia must be accompanied by a thorough discussion of risks and benefits with the patient (if clinically possible) and decision-makers 7