Evaluating Progression of Agitation in Alzheimer’s Disease

man with hand on head
man with hand on head
While there has been increasing understanding of Alzheimer's neuropathology, little is known about the relationship between progression of agitation and disease severity.
The following article is part of live conference coverage from the 2017 Psych Congress in New Orleans, Louisiana. Psychiatry Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in psychiatry, as well as presentations from the Congress. Visit Psychiatry Advisor’s conference section for continuous coverage live from Psych Congress 2017.

NEW ORLEANS — Although the underlying cause of Alzheimer’s disease (AD) remains elusive, significant advances have been made in the understanding of the pathophysiology and clinical presentation of the condition.  However, the condition continues to be associated with a significant personal, emotional, economic, and societal burden. Research targeted at assessing the progression of the symptoms may therefore help to identify effective treatments for the neuropsychiatric symptoms associated with AD.

To that end, Milena Anatchkova, PhD, and a team of researchers conducted a systematic literature review to assess the global burden of illness associated with agitation in AD.  Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the investigators identified 206 articles published between 2006 and 2016 that met predetermined inclusion criteria for summarizing the natural progression of agitation in AD, as well as neuropsychiatric symptom and disease severity. A total of 17 studies evaluated progression of agitation/neuropsychiatric symptoms over time, and 34 assessed the relationship between agitation/neuropsychiatric symptoms and severity of AD.

An increase in agitation prevalence was noted over time in 8 of 13 studies; however, regional differences were noted between European and US studies, with more European vs US studies documenting greater prevalence of agitation over time.  More US studies demonstrated little or no change in prevalence of frequency.

Most of the studies assessed (74%) reported a positive relationship between agitation/neuropsychiatric symptoms and AD severity.

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These results suggest an increase in neuropsychiatric symptoms over time, as well as greater prevalence and severity of agitation, as identified by the European studies; however, these differences may be attributed to culture or underrecognition of symptoms. Increased prevalence and incidence of agitation was also noted to be positively associated with severity of AD.

These findings suggest that progression of these core symptoms of AD may serve as a marker for disease severity, and that agitation may be a potential target to address to prevent or delay AD disability.


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Anatchkova M, Brooks A, Swett L, et al. The natural progression of agitation in Alzheimer’s disease/dementia: a systematic literature review. Poster presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.