Impact of Agitation, Aggression, Irritability, and Hyperactivity

Many clinicians may not be attentive to the fact that agitation, aggression, irritability, and hyperactivity are associated with a high degree of distress in patients and in formal and informal carers, surpassing even more defining symptoms of dementia such as memory problems. An analysis of data from a sample of 177 dementia carers supports this finding. Memory problems were the most frequent but least distressing symptom, whereas disruptive behavior was the least frequent but most distressing symptom. Irritability and agitation were equally distressing and significantly associated with the number of depressive symptoms in carers [73]. Several studies found an association between burden on formal and informal carers and BPSD, including agitation and aggression, across dementia severity and dementia types [74-77]. Moreover, agitation, aggression, and irritability are found to be very burdensome, also compared to other BPSD [78, 79] . Caring for a person with dementia is also associated with poor health and related outcomes, for example, self-reported poor health, reduced ability for self-care, higher mortality, higher stress levels, and poor sleep. Some of these outcomes are associated specifically with BPSD [80], but data are lacking with regard to agitation, aggression, irritability, and hyperactivity, although a relationship presumably exists.

BPSD also greatly impact the person with dementia and are associated with a decreased quality of life for both patients with dementia [81, 82] and carers [83]. Moreover, agitation/aggression can precipitate institutionalization and may also lead to a more rapid progression to severe dementia [84]. The presence of agitation/ aggression may also require administering medications with the risk of unwanted side effects and increased mortality. Lastly, agitation/aggression is associated with higher cost of care, thus conferring a further burden on society [85].

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