Non-Pharmacologic Approaches to Alzheimer's Disease Agitation: Interventions, Best Practices, and Case Examples

In 'Non-Pharmacologic Approaches to Alzheimer's Disease Agitation: Interventions, Best Practices, and Case Examples,' the expert neurologists examined the following critical questions: Before we get into the medications used to treat Alzheimer's disease agitation, what are the non-pharmacologic options and their respective roles?What are best practices for educating patients and caregivers on these and some case examples? Alireza Atri emphasized that non-pharmacologic interventions should always represent the first line of management for Alzheimer's disease agitation, with pharmacologic approaches reserved for situations involving immediate safety concerns or cases where behavioral strategies have proven insufficient. He described the biopsychosocial environmental framework as the foundation of care, highlighting that medication cleanup, addressing unmet needs, optimizing the environment, and educating and supporting care partners are essential early steps before any new pharmacologic treatment is considered. Anton Porsteinsson illustrated these principles through real-world case examples, including a patient whose agitation stemmed from understimulation and was resolved by pairing him with a companion who matched his active lifestyle, and another whose agitation in a nursing home was driven entirely by an incompatible roommate, noting that the DICE framework, which stands for describe, investigate, create, and evaluate, developed by Dr. Helen Kales, provides a structured and practical approach for clinicians to systematically identify triggers and develop individualized non-pharmacologic care plans. Throughout the conversation, the experts provided a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward. In the next episode, 'Traditional Pharmacologic Therapies for Alzheimer's Disease Agitation: Mechanisms, Evidence, and Adverse Events,' panelists continue their discussion on Alzheimer's disease agitation and highlight the traditional pharmacologic therapies including antipsychotics used in clinical practice, the evidence base supporting their use, and the adverse event profiles that clinicians must carefully weigh when considering these agents.