REAL-WORLD TREATMENT PATTERNS AND CLINICAL MANAGEMENT OF ALZHEIMER’S DISEASE AGITATION
Author(s)
Amita Patel, MD1, Courtney Zeni, PhD2, Mike Tocco, PhD2, Graham Eglit, PhD2, Yang Zhao, BS, PhD2.
1Private Practice, Dayton, OH, USA, 2Axsome Therapeutics, New York, NY, USA.
1Private Practice, Dayton, OH, USA, 2Axsome Therapeutics, New York, NY, USA.
OBJECTIVES: Alzheimer’s disease (AD) agitation is characterized by aggression, emotional distress, irritability, and disinhibition. Pharmacologic treatments often show variable efficacy and carry safety concerns. This chart review examined patterns in clinical management for AD agitation in community and long-term care (LTC) settings.
METHODS: A survey was conducted (September to October 2024) among 285 US healthcare providers (HCPs) treating patients with AD agitation. Each HCP provided data from 2 patient charts: 1 on first-line pharmacologic treatment and 1 on second- or third-line. Eligible patients had a possible or probable AD diagnosis and agitation symptoms relating to AD. Patient characteristics, initial agitation presentation, therapy, and reasons for discontinuation were examined.
RESULTS: A total of 570 charts (community: n=494; LTC: n=76) were analyzed (mean age: 78.8 years; female: 55%). Common psychiatric comorbidities included depression (32.6%) and anxiety (28.8%). Mean onset of agitation symptoms was 29.2 months (community: 29.8; LTC: 25.0) after AD diagnosis. Physical non-aggression (e.g., wandering, pacing, hoarding things, hiding things, general restlessness) was the most frequent initial symptom (overall: 74.8%; community: 75.2%; LTC: 72.4%), followed by verbal aggression (56.6%; 57.6%; 50.0%), and physical aggression (50.4%; 49.5%; 56.6%). Across all lines, atypical antipsychotics were most prescribed (overall: 55.5%; community: 56.7%; LTC: 47.7%), followed by SSRIs (29.3%; 29.6%; 27.1%) and benzodiazepines (23.2%; 21.8%; 32.7%). Lack of improvement was the leading reason for discontinuation (overall: 54.7%; community: 55.5%; LTC: 48.3%), followed by caregiver request (24.0%; 23.6%; 27.6%) and breakthrough agitation (21.3%; 20.1%; 31.0%).
CONCLUSIONS: In this chart review, agitation was initially reported at a mean of 29.2 months after AD diagnosis. Approximately half of patients reported initial physical aggression symptoms. Atypical antipsychotics were the most prescribed treatment, and lack of improvement was the primary reason for discontinuation across all medications. These findings may inform future approaches to optimizing care for patients with AD agitation.
METHODS: A survey was conducted (September to October 2024) among 285 US healthcare providers (HCPs) treating patients with AD agitation. Each HCP provided data from 2 patient charts: 1 on first-line pharmacologic treatment and 1 on second- or third-line. Eligible patients had a possible or probable AD diagnosis and agitation symptoms relating to AD. Patient characteristics, initial agitation presentation, therapy, and reasons for discontinuation were examined.
RESULTS: A total of 570 charts (community: n=494; LTC: n=76) were analyzed (mean age: 78.8 years; female: 55%). Common psychiatric comorbidities included depression (32.6%) and anxiety (28.8%). Mean onset of agitation symptoms was 29.2 months (community: 29.8; LTC: 25.0) after AD diagnosis. Physical non-aggression (e.g., wandering, pacing, hoarding things, hiding things, general restlessness) was the most frequent initial symptom (overall: 74.8%; community: 75.2%; LTC: 72.4%), followed by verbal aggression (56.6%; 57.6%; 50.0%), and physical aggression (50.4%; 49.5%; 56.6%). Across all lines, atypical antipsychotics were most prescribed (overall: 55.5%; community: 56.7%; LTC: 47.7%), followed by SSRIs (29.3%; 29.6%; 27.1%) and benzodiazepines (23.2%; 21.8%; 32.7%). Lack of improvement was the leading reason for discontinuation (overall: 54.7%; community: 55.5%; LTC: 48.3%), followed by caregiver request (24.0%; 23.6%; 27.6%) and breakthrough agitation (21.3%; 20.1%; 31.0%).
CONCLUSIONS: In this chart review, agitation was initially reported at a mean of 29.2 months after AD diagnosis. Approximately half of patients reported initial physical aggression symptoms. Atypical antipsychotics were the most prescribed treatment, and lack of improvement was the primary reason for discontinuation across all medications. These findings may inform future approaches to optimizing care for patients with AD agitation.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD111
Topic
Health Service Delivery & Process of Care
Disease
SDC: Geriatrics, SDC: Neurological Disorders