Agitation in Alzheimer's disease: Measurement and description

Abstract

Alzheimer's disease (AD) and related dementias are a major medical and social concern. AD is characterized by cognitive, behavioral, and affective changes. Agitation is reported as a significant behavioral problem in AD, but no standard definition has been used in the few existing studies and no reliable instrument exists for quantifying this phenomenon. This study attempts to describe and define agitation and related behavioral symptoms in a sample of Alzheimer patients, using an instrument that has been designed for this population. Additionally, the relationships between agitation, and caregiver psychological distress and satisfaction with outside caregiving help are examined.;Subjects were pairs of well-diagnosed community-residing Alzheimer patients and their primary caregivers. Caregivers rated their patients on the Agitation Checklist, and themselves on the Psychiatric Epidemiology Research Interview (PERI) Demoralization Scale, a measure of psychological distress. Patients were given the Blessed Test of Mental Status to estimate their level of cognitive impairment.;Agitated behavior is not rare or unusual, but was reported to occur during the previous week in some form in all of the patients studied. Agitation was found to be unrelated to level of cognitive impairment; however it was strongly correlated with the caregiver's rating of patient manageability. A weak relationship was found between psychological distress in caregivers and agitation in their patients.;The Agitation Checklist was found to have an alpha reliability of.82. Patterns of agitation for mild, moderate, and severely demented patients were discerned; while agitation is a ubiquitous phenomenon in AD, its presentation was found to vary through the course.;Caregiver demoralization was inversely correlated with patient manageability and directly correlated with cognitive impairment.;In summary, agitation is a problem of utmost clinical importance, affecting not only the patient but the family caregiver as well. The findings of the present study suggest that management approaches should be tailored to the particular behavior patterns exhibited by different patients. The Agitation Checklist is an instrument that can be used to define and quantify target symptoms.