Distinguishing Agitation From Aggression in Neurocognitive Disorders: A Systematic Review of Conceptualization, Assessment and Correlates

Background Aggressive behavior affects 30-50% of patients with dementia, yet agitation and aggression are frequently conflated despite distinct etiologies and treatment implications. Objectives To examine how many recent studies define and distinguish agitation from aggression in adults with dementia or related disorders. Methods A systematic review was conducted following a PROSPERO-registered protocol (CRD420251141548) and PRISMA guidelines. PubMed, Scopus, and Web of Science were searched for original studies published between 1st January 2017 and 28th February 2026. Definitions, assessment tools, and correlates were extracted. Study quality was appraised using CASP checklist. Results Of 236 identified studies, after deduplication 19 studies were reviewed in full. Only 5 studies distinguished agitation from aggression, all using the Cohen–Mansfield Agitation Inventory. Conclusions Failure to distinguish agitation from aggression remains common and likely contributes to suboptimal management and overuse of antipsychotic medications in neurocognitive disorders.