A consensus panel of clinical experts met in April 2026 to write practical guidance on agitation in Alzheimer dementia, aimed especially at primary care. It was published on 22 September.
The panel recommends a structured behavioural assessment with a validated tool, a search for reversible causes, and non-drug measures as the first step. When a drug is needed, the choice should rest on comparative efficacy and safety, and the aim should be less distress for patient and carer with function preserved, not sedation. It highlights the harms that have accompanied off-label use: excess mortality, cerebrovascular events, cognitive decline, falls and oversedation.
This is expert consensus rather than new trial evidence, and it fits the direction of existing guidance. Its strength is a clear sequence a busy clinician can follow.
- Rate agitation with a validated tool so that change can be measured.
- Look for pain, constipation, urinary retention, infection, drug side effects and poor sleep before prescribing.
- Start with non-drug measures: routine, lighting, reduced noise, carer education and meaningful activity.
- If a drug is needed, choose by safety profile, start low and review within weeks.
- Discuss the increased risk of stroke and death with antipsychotics with the family before starting one.
Why it matters
It puts preserved function and alertness, not a quiet patient, at the centre of the decision to prescribe.
Don't overread it
This is a consensus statement; it does not rank specific drugs on new evidence.
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