A Hidden Trigger Mimics Agitation in Alzheimer Disease Case Presentation
The Case
The Geriatric Psychiatry Consult team was asked to see a patient in the Special Care Unit of the Teaching Nursing Home. Ms Davis was a 92 y/o woman with advanced Alzheimer's Disease, Saint Louis University Mental Status (SLUMS) score of 2 /30 who was referred secondary to a 4-day history of verbal and physically agitated/aggressive behaviors, especially with hands-on care (HOC).
Medical History: Hypertension, hyperlipidemia, osteoarthritis, recurrent UTI's, major depression.
Medications: Lisinopril 10 mg od, rosuvastatin 20 mg od, prn acetaminophen, sertraline 100 mg od, trazodone 50 mg hs prn
Per nursing staff, the patient had exhibited pleasant/cooperative behavior until recently when she started screaming and striking out when they tried to change her diaper or get her bathed and dressed. At other times she sat quietly in the TV room napping on and off.
Our team went to see Ms Davis-she was slumped down in a recliner in the activity room.
As 2 of our medical students gently started to raise her up in the chair so that we could talk with her, she let out a blood-curdling scream and began flailing her arms in an attempt to strike out. We immediately recognized the trigger for her verbally and physically agitated behavior.
George T. Grossberg, MD, completed his medical degree at St. Louis University School of Medicine in Missouri and residency at St. Louis University Department of Psychiatry.
A Distinguished Fellow of the American Psychiatric Association, Dr Grossberg started the first Geriatric Psychiatry program in Missouri, and the first Alzheimer’s Disease Community Brain Bank. He is Past President of the American Association for Geriatric Psychiatry and International Psychogeriatric Association. He has been a leader in developing mental health programs and in treatment and research in geriatrics. In 2023, Dr Grossberg was named the Inaugural Henry & Amelia Nasrallah Endowed Professor in Geriatric Psychiatry at St Louis University School of Medicine.
Dr Grossberg has edited or authored 17 textbooks and published over 600 articles, chapters, and abstracts. He is a consultant in the development of protocols for central nervous system disorders in older patients, and is involved in basic as well as clinical research projects in the area of dementing disorders, with a focus on behavioral disturbances in dementia.
© 2025 HMP Global. All Rights Reserved.
Any views and opinions expressed above are those of the author(s) and do not necessarily reflect the views, policy, or position of the Neurology Learning Network or HMP Global, their employees, and affiliates.
