November 11, 2019

Massage, touch therapy, exercise, music therapy and other non-drug treatments can be an effective way to reduce aggression and agitation in people with Alzheimer’s disease, according to a new analysis. These non-drug treatments are far safer than medications and in many cases should be given priority in treating disruptive behaviors in people with dementia, the authors conclude.

For the study, researchers at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto looked at 163 previously published medical trials on treatments for aggression and agitation in people with Alzheimer’s disease and other forms of dementia. They found that a range of non-drug treatments could be effective in easing the agitation of Alzheimer’s disease.

Among the non-drug treatments that were proven to show benefit were massage and touch therapy, outdoor activities and exercise, and music therapy. Often these therapies were used in combination.

The analysis found that for many behavioral symptoms, non-drug treatments were more effective than medications. The findings suggest that “greater emphasis should be placed on nonpharmacologic approaches for treatment of aggression and agitation in persons with dementia,” the authors say. The study was published in Annals of Internal Medicine.

Agitation and aggression are extremely common problems in men and women in the more advanced stages of Alzheimer’s disease. As many as three out of four of those with Alzheimer’s disease will exhibit such symptoms as the disease progresses.

The emotional distress, physical and verbal aggression, irritability, and disruptive and unpredictable outbursts typical of agitation pose dangers for patients and caregivers alike. These behaviors also increase stress for those affected and those who care for them, and can lead to depression in caregivers. Agitation and aggression fall in the category of behaviors called disruptive behaviors and are common reasons why those with Alzheimer’s can no longer live at home and must be placed in a nursing home.

But good treatments for aggression and agitation are lacking. Antipsychotics and antidepressants are often prescribed to ease the behavioral problems of dementia, though they carry serious side effects. Some of these side effects are direct, such as strokes and cardiac toxicity that can lead to fatal heart attacks. Other side effects may indirectly lead to serious problems, including an increased risk of falls that can lead to broken bones. Furthermore, these drugs, and especially antidepressants, do not work that well for many people with Alzheimer’s disease.

Doctors say that benefits and risks of various therapies must be carefully weighed when treating agitation in people with Alzheimer’s. Sometimes drugs are the right choice for easing the agitation of dementia, especially in the case of an acute crisis. Non-drug treatments may in some cases also be appropriate as a complement to drug therapies, for example for longer-term treatment or perhaps as a prevention mechanism, allowing lower, and safer, doses of medications to be used.

Reducing noise and distractions in the home may also provide some relief. Regular medical and dental care is also essential to rule out pain and other health problems that may be increasing agitation.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: Jennifer A. Watt, MD, PhD; Zahra Goodarzi, MD, MSc; Areti Angeliki Veroniki, PhD; Vera Nincic, PhD; Paul A. Khan, PhD; Marco Ghassemi, MSc; Yuan Thompson, PhD; Andrea C. Tricco, PhD; and Sharon E. Straus, MD, MSc: “Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia A Systematic Review and Network Meta-analysis.” Annals of Internal Medicine, Oct. 14, 2019