Multimodal Management of Aggression in Dementia Among Geriatric Patients: A Comprehensive Overview With Particular Emphasis on Pharmacotherapy and Behavioral Interventions

Agitation and aggression are among the most common and clinically challenging behavioral and psychological symptoms of dementia in older adults. These manifestations worsen patients' daily functioning and increase the likelihood of hospitalization and long-term care placement. In addition, it imposes a significant burden on caregivers and healthcare systems. Their presentation is heterogeneous and reflects the complex interactions among neurodegenerative changes, medical comorbid conditions, environmental stressors, and the quality of care and communication. This review summarizes current approaches to the management of aggression in dementia, with a particular focus on multimodal strategies integrating behavioral, systemic, and pharmacological interventions. Emphasis is placed on non-pharmacological measures, which are widely regarded as first-line treatment due to their favorable safety profile and their potential to achieve sustained clinical benefits. These interventions include individualized behavioral strategies, environmental adaptations, structured daily activities, and caregiver education programs. Pharmacological treatment is discussed as a complementary option, appropriate primarily in cases of severe or persistent aggression or when there is an imminent risk to the patient or others. The review highlights the importance of cautious prescribing and using medications, limiting treatment duration, and regularly reassessing therapeutic effectiveness in relation to adverse effects, particularly in geriatric patients with multimorbidity. We also emphasize the need for an individualized approach, adjusted to the dementia subtype, overall medical condition, and prior treatment response. Ethical considerations are also addressed, including respect for patient dignity, minimization of coercive measures, and the responsibility of care institutions to create environments supportive of persons living with dementia. The available evidence supports a patient-centered, multimodal approach as the most balanced and effective strategy for managing aggression in dementia. Further pragmatic research is obligatory to refine integrated care models and to evaluate their effectiveness across diverse clinical settings.