“There’s Always Something We Can Do" for Agitation in Alzheimer Disease, Says Carolyn Clevenger, GNP

Agitation is among the most difficult neuropsychiatric symptoms encountered in Alzheimer disease (AD), affecting a large proportion of patients and exerting profound impact on caregivers, according to Carolyn Clevenger, GNP, professor of nursing at Emory University’s Nell Hodgson Woodruff School of Nursing and an expert in dementia care. Insights from her recent interview with Patient Care^© come at a time when agitation is increasingly recognized not as an unavoidable consequence of AD, but as a distinct clinical symptom that merits evaluation and targeted management.

Neuropsychiatric symptoms (NPS), including agitation, aggression, apathy, depression, anxiety, psychosis, and sleep disturbances, develop in most individuals with AD as the disease progresses and are strongly associated with accelerated cognitive and functional decline, earlier institutionalization, and significant caregiver strain.¹ NPS reflect a combination of neurobiologic changes and modifiable factors such as unmet needs, environmental triggers, and challenges in communication that arise with worsening cognitive impairment.¹

Agitation, in particular, often presents as restlessness, irritability, pacing, or verbal or physical aggression, and it frequently stems from pain, discomfort, confusion, or social and sensory stressors.² Yet many caregivers continue to believe that little can be done beyond sedation, an assumption that can delay intervention and overlook effective, person-centered approaches.

Growing evidence demonstrates that agitation is both identifiable and treatable through individualized nonpharmacologic strategies, optimized caregiving environments, structured behavioral interventions, and—when appropriate—judiciously selected medications. In the short video segment above, Clevenger underscores the importance of dispelling the notion that “nothing can be done,” encouraging caregivers and clinicians alike to recognize agitation as a manageable symptom and to seek timely support.

The following transcript has been lightly edited for style and flow.

Patient Care: About a quarter of the caregivers responding to the Agitation Blindspot survey said that they believe nothing can be done about agitation, and some may know about drugs that simply cause sedation. What message can clinicians offer to families now about what's actually possible?

Carolyn Clevenger: I've never been a fan of the phrase "there's nothing we can do." I just don't think that's helpful, and it's not true. But I think sometimes people get that message from a variety of lived experiences, things that they've seen. There is always something we can do. Maybe this is a symptom to palliate. I'm really grateful that we are starting to see more awareness—increasing awareness that agitation is a symptom, that it is something that your healthcare team can help you with, that there are other service providers in this space who are present and ready to lend a hand and support families. And often when we hear more about treatments, new treatments in particular, it does bring people to a space where they say, "I'm going to raise my hand. I'm experiencing this. I'm seeing it." So I think that's another reason for my distaste of this phrase "there's nothing we can do," because it prevents people from stepping forward and really understanding how prevalent the symptom is, how they specifically are experiencing that symptom in their day-to-day life, and then creating an opportunity for our team—not just your individual provider, but our whole healthcare team—to be able to provide support.

References

1. Lyketsos CG, Carrillo MC, Ryan JM, et al. Neuropsychiatric symptoms in Alzheimer’s disease. JAMA. 2011;305(9):945-952.

2. Cummings J, Mintzer J, Brodaty H, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. 2015;27(1):7-17.