How I Treat: Agitation Associated With Major Neurocognitive Disorder Treated with Behavioral Approaches Case Presentation

The patient is a 77-year-old married man with a 3-year history of progressive neurocognitive impairment who currently lives at home with his wife. He is a retired salesman who used to play drums in a local jazz band. In the last year he was diagnosed with Alzheimer disease. His wife reports that he alternates between spending excessive time in bed during the day or being restless—wandering around the house and having angry outbursts. His wife reports that it is unpredictable when he will explode, but she fears he will hurt himself, and on one occasion he left the house and she had to get the police to find him. He has several medical problems, including back pain, but is otherwise quite healthy and strong, having been an avid athlete who loved to work out and play basketball.

One of her main concerns is that he will often wake up at night to use the bathroom and wander around the house and then sleep much of the day. She thinks it is related to him drinking a lot of fluid including 1 or 2 beers after dinner and having to urinate a lot.

He saw his neurologist recently who noted him to be somewhat passive and inattentive during the interview and denied any problems. The patient got angry when the nurse tried to have him go with her to get his blood pressure taken in the next room, and his wife had to pull him away and calm him. His MMSE was 13 out of 30. The neurologist added memantine 5 mg with a plan to titrate it over the next 4 weeks to 10 mg twice daily and continued him on galantamine 8 mg twice daily. She also suggested that his wife consider adding a medication to help keep him calm during the day.