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This activity is funded by an independent medical education grant from Lundbeck. This activity is jointly provided by USF Health and touchIME in collaboration with the Gerontological Society of America (GSA).

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    Faculty & Disclosures
    Dr Carolyn Clevenger

    Emory Integrated Memory Care, Atlanta, GA, USA

    Dr Carolyn Clevenger is a gerontological nurse practitioner and a professor at the Nell Hodgson Woodruff School of Nursing at Emory University. She is a Fellow of the American Association of Nurse Practitioners, the Gerontological Society of America, and the American Academy of Nursing. Her research focuses on the geriatric nurse practitioner workforce, psychoeducation programmes for dementia family caregivers and new models of care. read more

    Dr Clevenger is the founder and director of the Emory Integrated Memory Care (IMC) Clinic. The IMC Clinic is a nurse-led primary care practice for people living with dementia, with the IMC in Community model also available in select senior living communities. This new model of care has been recognized as a Patient-Centred Medical Home, an Age Friendly Health System, a Best Practice exemplar for patient- and family-centred care, and one of the Best Programs for Caregiving.

    Dr Clevenger has led or collaborated on a variety of psychoeducation programmes for dementia family caregivers including the Savvy Caregiver® Program and Tele-Savvy Caregiver, Caregiving During Crisis, Caregiving While Black, and most recently, Caregiver as Navigator.

    She earned her Bachelor of Science in Nursing from West Virginia University, her Master of Science in Nursing from Emory University, and her Doctor of Nursing Practice from the Medical College of Georgia. She completed her postdoctoral fellowship at the US Department of Veterans Affairs.

    Dr Carolyn Clevenger discloses: Advisory board or panel fees from BrainCheck, Inc., Eli Lilly and Company, and Otsuka America Pharmaceutical Inc.
    Ms Kathleen Rhyne

    Emory Integrated Memory Care, Atlanta, GA, USA

    Kathleen Rhyne is a graduate of Bucknell University and received her Master of Business Administration from the Wharton School at the University of Pennsylvania. read more

    In midlife, she received her Master of Divinity degree from Lancaster Theological Seminary and served as an ordained United Church of Christ pastor, chaplain and spiritual director. She spent fifteen years as the care partner for her husband, Bill, as he navigated Alzheimer’s disease with severe agitation.

    Ms Kathleen Rhyne has no financial interests/relationships or affiliations in relation to this activity.
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    How confident are you in using the AAD decision tree when managing suspected AAD?

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    Which of the following aspects of care for AAD would you like more support with?

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    Effective care partner communication
       
    Supporting care partners emotionally
       
    Pharmacological treatment options
       
    Non pharmacological/psychosocial treatment options
       

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    In a typical month, what proportion of the patients you encounter experience agitation associated with Alzheimer’s dementia?

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    51–80%
       
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    Prevalence of agitation in Alzheimer's dementia
    Impact of agitation in Alzheimer's dementia on people living with dementia and their care partners
    How to recognize and diagnose early-stage agitation in Alzheimer's dementia
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    Alzheimer's Disease and Dementia, Neurodegenerative Diseases, Psychiatric Disorders CE/CME accredited

    touchIN CONVERSATION
    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Let’s talk about agitation in Alzheimer’s dementia: Prevalence, behavioural symptoms and reaching a diagnosis

    Faculty Podcast Featured
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    Learning Objectives

    After watching this activity, participants should be better able to:

    • Explain the prevalence of agitation in Alzheimer's dementia and the circumstances in which it may occur
    • Summarize the symptoms of agitation in Alzheimer's dementia and their impact on patients and care partners
    • Discuss how to identify early-stage agitation in Alzheimer's dementia and reach a diagnosis
    Overview

    In this activity, a gerontological nurse practitioner and a family care partner discuss the prevalence and typical presentation of agitation at different stages of Alzheimer’s dementia. Early recognition and diagnosis is important; it enables the implementation of best practice management strategies to reduce the overall burden of agitation for people living with Alzheimer’s dementia and their care partners.

    This activity is jointly provided by USF Health and touchIME in collaboration with the Gerontological Society of America (GSA).

    Target Audience

    This activity has been designed to meet the educational needs of Alzheimer’s disease specialists, neurologists, psychiatrists, primary care physicians, specialist nurse practitioners and physician assistants involved in the management of people living with dementia associated with Alzheimer’s disease.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Carolyn Clevenger discloses: Advisory board or panel fees from BrainCheck, Inc., Eli Lilly and Company, and Otsuka America Pharmaceutical Inc.

    Ms Kathleen Rhyne has no financial interests/relationships or affiliations in relation to this activity.

    Content reviewer

    Danielle Walker, DNP, APRN, AGNP-C has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Christina Mackins-Crabtree has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu 

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 18 July 2024. Date credits expire: 18 July 2025.

    If you have any questions regarding credit, please contact cpdsupport@usf.edu

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Alzheimer's Disease and Dementia / Neurodegenerative Diseases / Psychiatric Disorders
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    This Activity Is Funded By:

    An independent medical education grant from Lundbeck. This activity is jointly provided by USF Health and touchIME in collaboration with the Gerontological Society of America (GSA).

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 18 July 2024. Date credits expire: 18 July 2025.

    Claim Credit
    touchIN CONVERSATION
    Let’s talk about agitation in Alzheimer’s dementia: Prevalence, behavioural symptoms and reaching a diagnosis
    1.0 CE/CME credit
    Question 1/5
    Confusion, pain and discomfort can all trigger agitated behaviour in people living with Alzheimer's dementia, but what is the root cause of AAD?

    AAD, agitation in Alzheimer’s dementia.

    The psychological symptoms of dementia are likely to have a distinct neurochemical and neurobiological basis. Available evidence suggests that agitation in Alzheimer’s disease is associated with a serotonergic deficit, relatively preserved dopaminergic function and compensatory overactivity of postsynaptic noradrenergic neurons. 

    Reference

    Liu KY, et al. Ageing Res Rev. 2018;43:99–107.

    Question 2/5
    A care partner tells you they needed their daughter's help because their partner with Alzheimer’s dementia refused to get dressed one morning. What would be helpful for you to do as a healthcare professional to support the care partner and their loved one living with Alzheimer’s dementia?

    PLWD, person living with dementia.

    The first step in managing agitation is to properly define and assess the specific behaviours reported. These assessments should include information about frequency, duration, whom it affects, potential triggers, reinforcements of the behaviour and severity. It is important to obtain specific examples to determine if consensus exists about what has been witnessed. The degree of risk posed to the patient and others by the specific behaviour should also be assessed.

    Reference

    Wolf MU, et al. Continuum (Minneap Minn). 2018;24:783–803.

    Question 3/5
    Your 76-year-old male patient with Alzhemier’s dementia has recently been showing signs of agitation. His care partner (his wife) would like to know more about the potential impact of agitation on her husband. What information would you provide?

    AAD, agitation in Alzheimer’s dementia.

    AAD is associated with many negative outcomes. These include accelerated disease progression, physical and mental health deterioration, functional decline, higher risk of admission to LTCFs and poor quality of life. Notably, agitation is one of the most important factors that impacts whether a PLWD is placed in a LTCF. 

    Abbreviations

    AAD, agitation in Alzheimer’s dementia; LTCF, long-term care facility; PLWD, person living with dementia. 

    Reference

    Gerontological Society of America. Insights and Implications in Gerontology. August 2023. Available at: https://bit.ly/3HbJQyE  (accessed 2 July 2024).

    Question 4/5
    A care partner is becoming increasingly distressed and anxious that their behaviour may be exacerbating symptoms of agitation in their loved one who has Alzheimer’s dementia. What advice do you give them?

    Most of the time, agitation and anxiety happen for a reason. When they happen, it is important to try and find the cause. The Alzheimer’s Association provides tips on how to prevent and reduce agitation and these include: creating a calm environment; avoiding environmental triggers; monitoring personal comfort; simplifying tasks and routines; and providing opportunities for exercise.

    Reference

    Alzheimer’s Association. Available at: www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation (accessed 2 July 2024).

    Question 5/5
    What role does the AAD decision tree play in supporting clinical practice?

    The AAD decision tree for guiding the management of AAD outlines several steps that should be followed for assessing and managing AAD, starting with ongoing assessment for the emergence of symptoms, differential diagnosis, and nonpharmacologic and pharmacologic treatment approaches. It is complementary to the Describe, Investigate, Create and Investigate (DICE) framework, which can be used to creatively develop individualized care plans to proactively address care recipient needs and inform care interactions. The decision tree includes an optional step to assess the severity and frequency of the agitation behaviour.

    Abbreviations

    AAD, agitation in Alzheimer’s dementia; IPA, International Psychogeriatric Association.  

    Reference

    Gerontological Society of America. Insights and Implications in Gerontology. August 2023. Available at: https://bit.ly/3HbJQyE  (accessed 2 July 2024).

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    This Activity Is Funded By:

    An independent medical education grant from Lundbeck. This activity is jointly provided by USF Health and touchIME in collaboration with the Gerontological Society of America (GSA).

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 18 July 2024. Date credits expire: 18 July 2025.

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