This expert consensus, published in the Primary Care Companion for CNS Disorders on 22 September, reports the recommendations of a panel of specialists convened in April 2026 to guide agitation management in Alzheimer's dementia, with a focus on primary care.
The panel advised that the aim is to reduce distress for the patient and carer and to preserve function, not simply to sedate. It recommended a behavioural assessment with validated tools, a search for reversible causes, and non-drug approaches first. Where medicines are needed, choice should rest on efficacy and comparative safety, given the known harms of off-label management: excess deaths, stroke, cognitive decline, falls and sedation.
This restates principles many geriatricians hold, in a pathway designed for primary care, where most agitation is managed. It is expert opinion rather than a systematic guideline, and it does not change which drugs are licensed. Its emphasis on reversible causes and regular review applies wherever antipsychotics are started for agitation.
- Assess agitation with a validated tool and document its pattern and triggers.
- Look first for pain, infection, constipation, retention, sleep loss and medicine effects.
- Try non-drug approaches first, including routine, environment and carer support.
- If a medicine is needed, choose on safety, start low and set a review date.
- Review antipsychotics regularly and consider stopping when agitation settles.
Why it matters
Sedation has often been the default, with known costs in deaths, strokes and falls.
Don't overread it
This is expert consensus, not a systematic guideline or new trial evidence.
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