Agitation in dementia, including various kinds of distruptive, socially inappropriate behaviors, is one of the most distressing problem in caring dementia patients and a common precipitant of institutionalization. The development of agitation in
dementia patients can be associated with not only the neurobiological changes of brain, but also physical illnesses, psychopathological symptoms, environmental conditions, and cognitive decline. For the clinical management of agitation in
dementia,
the
first step we have to take is to check these clinical factors and correct etiologically associated conditions. Physical illness should be considered first as a precipitating factor, especially in the case of sudden onset of agitative symptoms. If
it is
difficult to find out manageable clinical condition, nonpharmacological approaches, modifying disruptive behaviors directly or changing environments indirectly, should be tried before the administration of psychotrophic medications. In
psychopharmacological approach, it is important to select relevant drugs considering patients' behavior pattern, drug effect and adverse reaction, and to start very low dose and increase slowly. After maintaining lowest effective dose for an
appropriate
period, empirical withdrawal of the medication should be considered.
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