Treating agitation in dementiaþ

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Painkillers may lessen agitation Agitation, a common dementia symptom, could be

better treated with simple painkillers rather than the riskier antipsychotic

drugs, according to a study. It found painkillers significantly cut agitation in

dementia patients. On the other hand, antipsychotics have a powerful sedative

effect, can worsen dementia symptoms, and increase the risk of stroke or even

death. They are often given to patients whose dementia makes them aggressive or

agitated. However, researchers from Kings College, London and Norway speculated

that the behaviour might sometimes be caused by pain, which patients were unable

to express in other ways. They studied 352 patients with moderate or severe

dementia in nursing homes in Norway. Half were given painkillers with every

meal, the rest continued with their usual treatments. After eight weeks, there

was a 17 per cent reduction in agitation symptoms in the group being given

painkillers - a greater improvement than would have been expected from treatment

with antipsychotics. The researchers concluded that if patient’s pain was

properly managed, doctors could reduce the number of prescriptions for

antipsychotic drugs. Professor Clive Ballard, one of the report authors and

director of research at the Alzheimer’s Society, said the finding was

significant. " At the moment, pain is very under-treated in people with dementia,

because it’s very hard to recognize. I think this could make a substantial

difference to people’s lives - it could help them live much better with

dementia, " he said. The study is published on the BMJ website.

B Rosenberg, associate professor of psychiatry and behavioral sciences1,

Constantine G Lyketsos, Plank Althouse professor1+ Author

Affiliations1Department of Psychiatry and Behavioral Sciences, s Hopkins

Bayview, s Hopkins Medicine, s Hopkins University,

Baltimore, MD, 21224, USA kostas@...

systematic pain management protocol may help Neuropsychiatric symptoms are

nearly universal in dementia,1 and agitation is among the most distressing for

patients and caregivers. Currently no drug has clearly been shown to be of value

in the treatment of agitation in dementia. The

most commonly used class of drugs (antipsychotics) may be neither safe nor

effective. 23 Although antidepressants may have a

better risk to benefit ratio, no sufficiently powered trials have evaluated

their safety and efficacy in dementia, and only

one is currently in progress. 4 Patients may be

unable to communicate their sensation of pain because of impaired memory or lack

of expressive language. Underdiagnosed and

undertreated pain has been associated with agitation in dementia.

5 Thus, better pain management may decrease agitation in dementia.

To test this hypothesis, the linked randomised controlled trial by Husebo and

colleagues (doi:10.1136/bmj.d4065) assessed an eight week trial of pain

treatment in 253 nursing home residents with dementia and agitation.

6 Treatment allocation used a cluster approach at the nursing home level because

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