The Challenge of Dementia-Related Agitation

At the forefront of dementia care, healthcare professionals have long grappled with the overwhelming challenge of managing agitation in patients—without effective, FDA-approved treatments at their disposal. Dr. Gerald Maguire, a leading psychiatrist, highlighted these concerns during the 2025 Southern California Psychiatry Conference, revealing that a staggering 50% of patients with Alzheimer’s disease experience aggression.

A Promising New Treatment Emerges

Traditionally, clinicians faced a lack of safe options, often resorting to antipsychotic drugs that come with serious warnings about increased mortality and cerebrovascular risks. Dr. Maguire lamented, "For years... we had nothing FDA approved to treat them." Thankfully, the tide is beginning to turn. In 2023, Brexpiprazole (Rexulti) was approved for dementia-related agitation, ushering in a new era of hope. This innovative medication operates across three key monoamine systems: noradrenergic, serotonin, and dopamine.

Exploring Future Possibilities

But the excitement doesn't stop there. Dr. Maguire also mentioned AXS-05, a combination of bupropion and dextromethorphan, which has shown promise in recent trials. This could mean more effective treatment options are on the horizon for dementia patients.

Beyond Medications: The Importance of Holistic Care

Despite these new pharmacological strategies, Dr. Maguire stressed the importance of thoroughly evaluating non-pharmacologic and medical conditions that may underlie agitation. He cautioned, "Before we go adding on another medicine, make sure that we know medically what’s also going on for that patient." Factors like environmental changes, untreated pain, and other medical issues must be carefully assessed to craft a truly effective treatment plan.

The Stakes are High: Timely Interventions Matter

The urgency for timely interventions cannot be overstated. Dr. Maguire emphasized that untreated agitation can lead to poor prognostic outcomes. Effective management of agitation not only enhances patients' quality of life but also helps delay the need for more restrictive care settings. "The longer we can keep patients at home, surrounded by their family members, the better," he affirmed.