Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition

doi:10.1017/S1041610222001041

Review

. 2024 Apr;36(4):238-250.

doi: 10.1017/S1041610222001041. Epub 2023 Mar 7.

Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition

Mary Sano¹, Jeffrey Cummings², Stefanie Auer³, Sverre Bergh⁴, Corinne E Fischer⁵, Debby Gerritsen⁶, George Grossberg⁷, Zahinoor Ismail⁸, Krista Lanctôt⁹, Maria I Lapid¹⁰, Jacobo Mintzer¹¹, Rebecca Palm¹², Paul B Rosenberg¹³, Michael Splaine¹⁴, Kate Zhong¹⁵, Carolyn W Zhu¹⁶

Affiliations

¹ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx, NY, USA.
² Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA.
³ Centre for Dementia Studies, University for Continuing Education Krems, Austria.
⁴ The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.
⁵ Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada.
⁶ Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands.
⁷ Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, St Louis University School of Medicine, St Louis, MO, USA.
⁸ Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O'Brien Institute for Public Health University of Calgary, Calgary, AB, Canada.
⁹ Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
¹⁰ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
¹¹ Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
¹² Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany.
¹³ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁴ Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC.
¹⁵ Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
¹⁶ Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx, NY, USA.

PMID: 36880250
PMCID: PMC10684256
DOI: 10.1017/S1041610222001041

Review

Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition

Mary Sano et al. Int Psychogeriatr. 2024 Apr.

. 2024 Apr;36(4):238-250.

doi: 10.1017/S1041610222001041. Epub 2023 Mar 7.

Authors

Affiliations

¹ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NYC NY and James J. Peters VAMC, Bronx, NY, USA.
² Joy Chambers-Grundy Professor of Brain Science, Director, Chambers-Grundy Center for Transformative Neuroscience, Co-Director, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA.
³ Centre for Dementia Studies, University for Continuing Education Krems, Austria.
⁴ The Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.
⁵ Faculty of Medicine, Department of Psychiatry, University of Toronto, Canada.
⁶ Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Radboud Alzheimer Center, Nijmegen, the Netherlands.
⁷ Department of Psychiatry & Behavioral Neuroscience, Division of Geriatric Psychiatry, St Louis University School of Medicine, St Louis, MO, USA.
⁸ Departments Psychiatry, Neurology, Epidemiology, and Pathology, Hotchkiss Brain Institute & O'Brien Institute for Public Health University of Calgary, Calgary, AB, Canada.
⁹ Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute; and Departments of Psychiatry and Pharmacology/Toxicology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
¹⁰ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
¹¹ Psychiatrist, Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
¹² Department of Nursing Science, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany.
¹³ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹⁴ Owner Splaine Consulting, Managing Partner, Recruitment Partners LLC.
¹⁵ Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
¹⁶ Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, NYC, NY and James J. Peters VAMC, Bronx, NY, USA.

PMID: 36880250
PMCID: PMC10684256
DOI: 10.1017/S1041610222001041

Abstract

Background: The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove "provisional" from the definition.

Methods: This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition.

Results: We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions.

Conclusion: The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.

Keywords: Alzheimer’s disease; Behavioral and Psychological Symptoms of Dementia; International Psychogeriatric Association; aggression; agitation; dementia; neuropsychiatric symptoms.

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Figures

**Figure 1.**
Number of clinical trials by year which used specific criteria to define agitation (01/01/2015 to 07/01/2021).

See this image and copyright information in PMC

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References

1. Panca M, Livingston G, Barber J, et al. Healthcare resource utilisation and costs of agitation in people with dementia living in care homes in England - The Managing Agitation and Raising QUality of LifE in Dementia (MARQUE) study. PLoS One. 2019;14(2):e0211953. doi:10.1371/journal.pone.0211953 - DOI - PMC - PubMed
1. Halpern R, Seare J, Tong J, Hartry A, Olaoye A, Aigbogun MS. Using electronic health records to estimate the prevalence of agitation in Alzheimer disease/dementia. Int J Geriatr Psychiatry. Mar 2019;34(3):420–431. doi:10.1002/gps.5030 - DOI - PMC - PubMed
1. Van der Mussele S, Le Bastard N, Saerens J, et al. Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer’s dementia. Aging Ment Health. 2015;19(3):247–57. doi:10.1080/13607863.2014.924900 - DOI - PubMed
1. Cummings J, Mintzer J, Brodaty H, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. Jan 2015;27(1):7–17. doi:10.1017/S1041610214001963 - DOI - PMC - PubMed
1. Selbaek G, Engedal K, Benth JS, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Int Psychogeriatr. Jan 2014;26(1):81–91. doi:10.1017/S1041610213001609 - DOI - PubMed

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[1] Panca M, Livingston G, Barber J, et al. Healthcare resource utilisation and costs of agitation in people with dementia living in care homes in England - The Managing Agitation and Raising QUality of LifE in Dementia (MARQUE) study. PLoS One. 2019;14(2):e0211953. doi:10.1371/journal.pone.0211953 - DOI - PMC - PubMed

[2] Panca M, Livingston G, Barber J, et al. Healthcare resource utilisation and costs of agitation in people with dementia living in care homes in England - The Managing Agitation and Raising QUality of LifE in Dementia (MARQUE) study. PLoS One. 2019;14(2):e0211953. doi:10.1371/journal.pone.0211953 - DOI - PMC - PubMed

[3] Halpern R, Seare J, Tong J, Hartry A, Olaoye A, Aigbogun MS. Using electronic health records to estimate the prevalence of agitation in Alzheimer disease/dementia. Int J Geriatr Psychiatry. Mar 2019;34(3):420–431. doi:10.1002/gps.5030 - DOI - PMC - PubMed

[4] Halpern R, Seare J, Tong J, Hartry A, Olaoye A, Aigbogun MS. Using electronic health records to estimate the prevalence of agitation in Alzheimer disease/dementia. Int J Geriatr Psychiatry. Mar 2019;34(3):420–431. doi:10.1002/gps.5030 - DOI - PMC - PubMed

[5] Van der Mussele S, Le Bastard N, Saerens J, et al. Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer’s dementia. Aging Ment Health. 2015;19(3):247–57. doi:10.1080/13607863.2014.924900 - DOI - PubMed

[6] Van der Mussele S, Le Bastard N, Saerens J, et al. Agitation-associated behavioral symptoms in mild cognitive impairment and Alzheimer’s dementia. Aging Ment Health. 2015;19(3):247–57. doi:10.1080/13607863.2014.924900 - DOI - PubMed

[7] Cummings J, Mintzer J, Brodaty H, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. Jan 2015;27(1):7–17. doi:10.1017/S1041610214001963 - DOI - PMC - PubMed

[8] Cummings J, Mintzer J, Brodaty H, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr. Jan 2015;27(1):7–17. doi:10.1017/S1041610214001963 - DOI - PMC - PubMed

[9] Selbaek G, Engedal K, Benth JS, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Int Psychogeriatr. Jan 2014;26(1):81–91. doi:10.1017/S1041610213001609 - DOI - PubMed

[10] Selbaek G, Engedal K, Benth JS, Bergh S. The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period. Int Psychogeriatr. Jan 2014;26(1):81–91. doi:10.1017/S1041610213001609 - DOI - PubMed

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Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition

Affiliations

Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition

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