Defining agitation, apathy and other psychiatric symptoms in cognitive impairment and dementia: Why we need to intervene

Abstract

AbstractBackgroundInternational Psychiatric Association (IPA) has a long history of defining and treating the behavioral and psychiatric symptoms that occur with cognitive impairment and dementia, including agitation and apathy. This presentation will describe the international and collaborative approach to creating definitions and diagnoses. Also a description of how these efforts have fostered trial design and can direct development of protocols with evidence‐ based selection of populations and meaningful outcomes.MethodThe methodology used by the IPA and other associations to characterize behavioral symptoms in aging and dementia begins with a review of the extant literature and the creation of a survey around the key elements of the diagnosis or definition of a given condition such as agitation or apathy. Elements of the definition are selected from the field and the surveys are disseminated via a link in an email. The email is distributed widely, to member of IPA and to its more than 20 different affiliates, which represent national organizations in geriatric psychiatry and allied fields. International working groups use the responses to formulate criteria that have meaning and importance to the largest number of stakeholders including, providers, regulators, researchers and patient advocates. The uptake of the criteria and their success in defining treatable conditions is monitored and in interactive process of updating the definitions to improve clinical utility is promoted.ResultThis approach has been used to create guidelines for defining agitation, apathy and psychosis. The presentation will include a review of the results of this process for agitation in which the publication of the provisional guidelines were followed by a notable increase in clinical trials and other research to address interventions and in work to improve outcome measures. Recent work in apathy has also provided support for selecting clinically relevant outcomes including measures of function, cognition and caregiver burden.ConclusionInternational collaboration to define psychiatric and behavioral symptoms associated with cognitive impairment can provide the stimulus to developing meaningful interventions.