American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for severe agitation in a patient with dementia?

1. Haloperidol

2. Quetiapine

3. Divalproex sodium

4. Benzodiazepines

The correct answer is: Quetiapine

The recommended treatment for severe agitation in a patient with dementia is quetiapine, an atypical antipsychotic. Quetiapine is often favored in this context due to its relatively favorable side effect profile compared to other antipsychotics. It has been shown to help manage agitation effectively while potentially minimizing the risk of extrapyramidal symptoms, which are more common with first-generation antipsychotics like haloperidol. In dementia patients, where there are concerns about sedative properties and cognitive impairment, quetiapine can offer a balance between efficacy and tolerance. Moreover, atypical antipsychotics are often preferred because they tend to have a lower risk of adverse effects associated with traditional antipsychotic medications, particularly in older adults. Other treatments, such as divalproex sodium, while sometimes used for agitation due to its mood-stabilizing properties, are less first-line due to variable efficacy and potential side effects in this population. Benzodiazepines may also be effective for agitation but come with a higher risk of sedation, dependence, and cognitive impairment, making them less desirable for long-term management in dementia patients. This highlights the importance of selecting a treatment that balances efficacy with tolerability in a vulnerable population.