Management of Restlessness in Alzheimer's Disease

Nonpharmacologic Interventions

• The American Academy of Family Physicians recommends establishing a predictable daily routine with consistent exercise, meals, and bedtime schedules for patients with Alzheimer's disease to manage restlessness 1
• The American Academy of Family Physicians suggests using distraction and redirection techniques, such as the "three R's": repeat, reassure, and redirect, when agitation occurs in patients with Alzheimer's disease 3, 4
• Simplifying tasks by breaking them into manageable steps with clear instructions is recommended by the American Academy of Family Physicians for patients with Alzheimer's disease to reduce restlessness 1
• Ensuring optimal treatment of comorbid conditions that may contribute to restlessness is advised by the American Academy of Family Physicians for patients with Alzheimer's disease 1
• Creating a safe environment with reduced environmental stimuli, such as minimizing glare, noise, and household clutter, is recommended by the American Academy of Family Physicians for patients with Alzheimer's disease to manage restlessness 1
• Using appropriate lighting to reduce confusion and restlessness at night is suggested by the American Academy of Family Physicians for patients with Alzheimer's disease 1
• Avoiding overstimulation and crowded places that can trigger agitation is advised by the American Academy of Family Physicians for patients with Alzheimer's disease 1
• Registering the patient in the Alzheimer's Association Safe Return Program is recommended by the American Academy of Family Physicians if wandering is a concern for patients with Alzheimer's disease 3

Pharmacologic Interventions

• Cholinesterase inhibitors may improve behavioral symptoms, including restlessness, in patients with Alzheimer's disease, according to the American Academy of Family Physicians 2, 3
• The American Academy of Family Physicians recommends the following cholinesterase inhibitors for the treatment of restlessness in Alzheimer's disease:
• For restlessness with depression, the American Academy of Family Physicians recommends SSRIs, such as citalopram (Celexa) and sertraline (Zoloft), due to their minimal anticholinergic effects 3, 4, 5
• For restlessness with agitation, the American Academy of Family Physicians suggests beginning with structured activities, reassurance, and socialization alongside medication for mild agitation, and medication plus environmental interventions for safety for severe agitation 5
• The American Academy of Family Physicians advises starting psychotropic medications at low doses and increasing slowly while monitoring for side effects 3
• After behavioral disturbances have been controlled for 4-6 months, the American Academy of Family Physicians recommends attempting gradual dose reduction to determine if continued pharmacotherapy is needed 3
• Regularly reassessing the need for medication and adjusting based on response is advised by the American Academy of Family Physicians 3
• The American Academy of Family Physicians warns that some behaviors, like wandering and pacing, may not respond well to drug therapy 4
• Avoiding medications with high anticholinergic effects, as they can worsen cognition, is recommended by the American Academy of Family Physicians 3
• The American Academy of Family Physicians notes that cholinesterase inhibitors may initially increase agitation before improvement occurs 2
• Considering the possibility that restlessness may be due to pain, discomfort, or other medical conditions that should be addressed is advised by the American Academy of Family Physicians 1