Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions
Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in f...
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Frontiers Media S.A.
2021-04-01
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Series: | Frontiers in Neurology |
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Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.644317/full |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Claudia Carrarini Mirella Russo Fedele Dono Filomena Barbone Marianna G. Rispoli Laura Ferri Martina Di Pietro Anna Digiovanni Paola Ajdinaj Rino Speranza Alberto Granzotto Alberto Granzotto Alberto Granzotto Valerio Frazzini Valerio Frazzini Valerio Frazzini Astrid Thomas Andrea Pilotto Andrea Pilotto Alessandro Padovani Marco Onofrj Marco Onofrj Stefano L. Sensi Stefano L. Sensi Laura Bonanni Laura Bonanni |
spellingShingle |
Claudia Carrarini Mirella Russo Fedele Dono Filomena Barbone Marianna G. Rispoli Laura Ferri Martina Di Pietro Anna Digiovanni Paola Ajdinaj Rino Speranza Alberto Granzotto Alberto Granzotto Alberto Granzotto Valerio Frazzini Valerio Frazzini Valerio Frazzini Astrid Thomas Andrea Pilotto Andrea Pilotto Alessandro Padovani Marco Onofrj Marco Onofrj Stefano L. Sensi Stefano L. Sensi Laura Bonanni Laura Bonanni Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions Frontiers in Neurology agitation dementia hyperkinetic delirium Alzheimer's Disease Dementia with Lewy Bodies Frontotemporal Dementia |
author_facet |
Claudia Carrarini Mirella Russo Fedele Dono Filomena Barbone Marianna G. Rispoli Laura Ferri Martina Di Pietro Anna Digiovanni Paola Ajdinaj Rino Speranza Alberto Granzotto Alberto Granzotto Alberto Granzotto Valerio Frazzini Valerio Frazzini Valerio Frazzini Astrid Thomas Andrea Pilotto Andrea Pilotto Alessandro Padovani Marco Onofrj Marco Onofrj Stefano L. Sensi Stefano L. Sensi Laura Bonanni Laura Bonanni |
author_sort |
Claudia Carrarini |
title |
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions |
title_short |
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions |
title_full |
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions |
title_fullStr |
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions |
title_full_unstemmed |
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions |
title_sort |
agitation and dementia: prevention and treatment strategies in acute and chronic conditions |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2021-04-01 |
description |
Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients. |
topic |
agitation dementia hyperkinetic delirium Alzheimer's Disease Dementia with Lewy Bodies Frontotemporal Dementia |
url |
https://www.frontiersin.org/articles/10.3389/fneur.2021.644317/full |
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doaj-fb90d056a6254933b97f40c65826deb42021-04-16T04:58:45ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-04-011210.3389/fneur.2021.644317644317Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic ConditionsClaudia Carrarini0Mirella Russo1Fedele Dono2Filomena Barbone3Marianna G. Rispoli4Laura Ferri5Martina Di Pietro6Anna Digiovanni7Paola Ajdinaj8Rino Speranza9Alberto Granzotto10Alberto Granzotto11Alberto Granzotto12Valerio Frazzini13Valerio Frazzini14Valerio Frazzini15Astrid Thomas16Andrea Pilotto17Andrea Pilotto18Alessandro Padovani19Marco Onofrj20Marco Onofrj21Stefano L. Sensi22Stefano L. Sensi23Laura Bonanni24Laura Bonanni25Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyBehavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology–CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyInstitute for Mind Impairments and Neurological Disorders–iMIND, University of California, Irvine, Irvine, CA, United StatesBehavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology–CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyInstitut du Cerveau et de la Moelle épinière, ICM, INSERM UMRS 1127, CNRS UMR 7225, Pitié Salpêtrière Hospital, Paris, FranceAP-HP, GH Pitie-Salpêtrière-Charles Foix, Epilepsy Unit and Neurophysiology Department, Paris, FranceDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyNeurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyParkinson's Disease Rehabilitation Centre, FERB ONLUS–S. Isidoro Hospital, Trescore Balneario, ItalyNeurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyBehavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology–CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyBehavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology–CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyDepartment of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyBehavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology–CAST, University G. d'Annunzio of Chieti-Pescara, Chieti, ItalyAgitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients.https://www.frontiersin.org/articles/10.3389/fneur.2021.644317/fullagitationdementiahyperkinetic deliriumAlzheimer's DiseaseDementia with Lewy BodiesFrontotemporal Dementia |