How I Treat Alzheimer With Agitation: Addressing Underlying Mood Disorders Case Presentation

A 76-year-old woman with a history of Alzheimer disease, hypertension, sleep apnea, and macular degeneration was brought by her family to the memory clinic for evaluation and management of agitation. 

She had been previously diagnosed with dementia due to Alzheimer disease. She had a history of progressive memory loss that started about 2 years ago. She was forgetting appointments and getting confused with her mail. She was repeating herself over and over again. She also had difficulty operating the TV remote or her phone and had trouble recognizing people and managing her finances. So, her family members had started to help her although she continued to live independently.

Her symptoms progressed over time and her children started to notice that she was not taking care of herself. She was wearing inappropriate clothes and her house was in disarray; she had not bathed or showered in a while. So the family hired professional aides to provide care. However, the patient resisted this, and became verbally and physically aggressive towards them. She would throw things at them, yell or swear at them, and even scratch them. A number of aides left because of her behavior. 

She was prescribed an SSRI for her behaviors but it did not seem to help, and her behaviors continued to worsen.   

When she was seen in the office, she was very restless, and was pacing around. She was yelling loudly and demanded to leave. The patient was admitted to a geriatric psychiatry inpatient unit since she could not take care of herself on her own and her agitation was preventing the caregivers from providing care. The workup, including a complete blood count, comprehensive metabolic panel, and urinalysis, were unremarkable.