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VPA agitation alzheimer's

Leszek Bidzan, Jakub Grabowski, Beata Dutczak, Mariola Bidzan
UNLABELLED: Aggressive and impulsive behaviour are common in Alzheimer's dementia. Therapy of these disorders is an important but difficult practical question. AIM: The purpose of this study was to determine the effect of pharmacological treatment of aggressive behaviour, while taking into account the dynamics of disease progression during observation. In the assessment of treatment acetylcholinesterase inhibitors (IAChE), valproic acid (VA), and antipsychotics were considered...
May 2012: Psychiatria Polska
J E Mintzer, D F Mirski, K S Hoernig
Alzheimer's disease typically presents with two often overlapping syndromes, one cognitive, the other behavioral. The behavioral syndrome is characterized by psychosis, aggression, depression, anxiety, agitation, and other common if less well-defined symptoms subsumed under the umbrella entity "behavioral and psychological symptoms of dementia" (BPSD), itself divided into a number of subsyndromes: psychosis, circadian rhythm (sleepwake) disturbance, depression, anxiety, and agitation, it is BPSD with its impact on care providers that ultimately precipitates the chain of events resulting in long-term institutional care...
June 2000: Dialogues in Clinical Neuroscience
Pierre N Tariot, Lon S Schneider, Jeffrey Cummings, Ronald G Thomas, Rema Raman, Laura J Jakimovich, Rebekah Loy, Barbara Bartocci, Adam Fleisher, M Saleem Ismail, Anton Porsteinsson, Michael Weiner, Clifford R Jack, Leon Thal, Paul S Aisen
CONTEXT: Agitation and psychosis are common in Alzheimer disease and cause considerable morbidity. We attempted to delay or to prevent agitation and psychosis with the use of divalproex sodium (valproate). OBJECTIVE: To determine whether treatment with valproate could delay or prevent emergence of agitation or psychosis. DESIGN, SETTING, AND PATIENTS: A multicenter, randomized, double-blind, placebo-controlled trial of flexible-dose valproate in 313 (of 513 screened) individuals with moderate Alzheimer disease who had not yet experienced agitation or psychosis...
August 2011: Archives of General Psychiatry
Haibing Xiao, Ying Su, Xu Cao, Shenggang Sun, Zhihou Liang
The objective of this study was to assess the clinical evidence for or against mood stabilizers as a treatment for Alzheimer's disease (AD). We searched 5 databases from their inception to January 2010. Five randomized clinical trials of mood stabilizers to treat human patients suffering from AD were included. These trials assessed the effectiveness of mood stabilizers as an adjunct treatment to conventional anti-dementia drugs on behavioral and psychological symptoms, especially on agitation. Methodological quality was assessed using the Jadad score...
October 2010: Journal of Huazhong University of Science and Technology. Medical Sciences
Christian Dolder, Jonathan McKinsey
Adequate treatment of behavioral disturbances in Alzheimer's disease is both important and difficult. This report describes a case series that examined the effectiveness and safety of low-dose divalproex in the treatment of agitated patients with Alzheimer's disease who were admitted to an inpatient geriatric psychiatry unit over a 1-year period. All patients had agitation due to probable Alzheimer's disease or mixed dementia and were prescribed divalproex monotherapy at low and completely flexible doses. Patients and nursing staff were blind to study enrollment...
January 2010: Journal of Psychiatric Practice
P Gareri, R Lacava, A Cotroneo, V Bambara, N Marigliano, A Castagna, D S Costantino, G Ruotolo, G de Sarro
In this study we report a case of valproate-induced delirium in a patient affected with Alzheimer's disease (AD). A 75-year-old woman with AD presented moderate cognitive impairment associated to behavioral disorders, characterized by aggression, agitation, severe insomnia. She was treated with galantamine, promazine, acetylsalicylic acid and pantoprazole. Since behavioral disorders worsened more and more, home neurological consultation was asked. The neurologist prescribed a mood stabilizer, sodium valproate 500 mg daily for the first week and then, twice a day and stopped promazine...
2009: Archives of Gerontology and Geriatrics
D Pinheiro
INTRODUCTION: Dementia, besides the dominant cognitive disorders that define it, is associated with behavioral disturbances, the consequences of which are, on various levels, a determining factor for the handling of these patients. The treatment of behavioral and psychological symptoms is essential and although, to date, no therapeutic solution is satisfactory, it is necessary to look for an alternative to the neuroleptics usually employed, which raise real problems of tolerance in this geriatric population...
September 2008: L'Encéphale
Nathan Herrmann, Krista L Lanctôt, Lana S Rothenburg, Goran Eryavec
BACKGROUND/AIMS: To assess the efficacy and tolerability of valproate for the treatment of agitation and aggression in moderate-to-severe Alzheimer's disease (AD). METHODS: This was a randomized, double-blind, placebo-controlled crossover trial of valproate in institutionalized AD patients. Patients were assessed with the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory at baseline and after 6 weeks of treatment with valproate and placebo, with 2 weeks between phases to allow for placebo washout and tapering...
2007: Dementia and Geriatric Cognitive Disorders
Louis A Profenno, Laura Jakimovich, Connie J Holt, Anton Porsteinsson, Pierre N Tariot
OBJECTIVE: The Alzheimer's Disease Cooperative Study (ADCS) is conducting a clinical trial to address whether chronic valproate treatment can delay emergence of behavioral symptoms in outpatients with AD. Since there were no data on the safety and tolerability of divalproex sodium in outpatients with dementia, we undertook a pilot study to inform the design of the ADCS study. METHODS: We recruited 20 outpatients with probable AD, MMSE 10-20, without history of agitation or psychosis...
December 2005: Current Alzheimer Research
Pierre N Tariot, Rema Raman, Laura Jakimovich, Lon Schneider, Anton Porsteinsson, Ronald Thomas, Jacobo Mintzer, Ronald Brenner, Kim Schafer, Leon Thal
OBJECTIVE: Three placebo-controlled clinical trials have suggested the benefit of valproate for treatment of agitation associated with dementia; one was used as the basis for this multicenter trial, conducted by the Alzheimer's Disease (AD) Cooperative Study. It addresses the efficacy, safety, and tolerability of divalproex sodium for the treatment of agitation associated with dementia. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial in 153 nursing home residents with probable or possible AD complicated by agitation; 110 (72%) completed the trial...
November 2005: American Journal of Geriatric Psychiatry
Richard A Rosin, Murray A Raskind
No medication has received regulatory approval in the U.S.A. for the distressing agitation and aggressive behaviors that often complicate dementia. Although studies suggest that several psychotropic medications are sometimes useful for these behavioral problems, response is variable and adverse effects often limit treatment. Theoretical considerations suggest that increasing estrogenic activity or reducing androgenic activity could reduce agitation and aggression in dementia. Estrogen has been reported helpful for these symptoms, but adverse effects are problematic...
June 2005: International Psychogeriatrics
Pierre N Tariot
The literature regarding the use of valproate in the elderly derives primarily from studies in patients with dementia who experience agitation. At this juncture, there are 5 case reports or case series in patients with mixed neuropsychiatric disorders and 18 in patients with dementia, while there are 3 placebo-controlled studies in patients with dementia. In the aggregate, the published reports point toward probable improvement in agitation in a substantial proportion of patients. The level of evidence is not sufficient to define clinical practice, however, which is also a limitation with some other commonly used therapies, nor is the behavioral target of persistent agitation recognized by the Food and Drug Administration...
2003: Psychopharmacology Bulletin
Hubert Vance, Curtis Kauffman, Barney Miller, Talaat Mansour
No abstract text is available yet for this article.
2003: Psychiatry
Anton P Porsteinsson, Pierre N Tariot, Laura J Jakimovich, Nancy Kowalski, Connie Holt, Rosemary Erb, Christopher Cox
OBJECTIVE: The authors describe an open-label extension of a double-blind, randomized, placebo-controlled study of divalproex sodium in 56 nursing home patients with agitation and dementia. METHODS: Participants (N=46) were treated for 6 weeks in an open fashion with clinically optimal doses of divalproex sodium (range: 250 mg/day-1,500 mg/day; mean: 851 mg/day). Behavior was assessed with the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Change (CGI) by new raters...
July 2003: American Journal of Geriatric Psychiatry
Rebekah Loy, Pierre N Tariot
Neuropsychiatric disturbances are extremely common in Alzheimer's disease (AD), and represent integral features of the illness, as well as appropriate targets for therapy. We are interested in designing trials aimed at preventing or delaying the emergence of psychopathology in AD. For symptomatic treatment of agitation, mood stabilizers, particularly sodium valproate, have proved to be beneficial in some patients. Since these effects take several weeks to emerge, we considered that they might be dependent on potentially neuroprotective actions of valproate, such as inhibition of apoptosis and slowing of neurofibrillary tangle formation...
December 2002: Journal of Molecular Neuroscience: MN
Pierre N Tariot, Rebekah Loy, J Michael Ryan, Anton Porsteinsson, Saleem Ismail
OBJECTIVE: This paper provides a case study of 'reverse translational research', in which empirical clinical trials focused on relieving psychopathological symptoms of Alzheimer's disease (AD) ultimately led to mechanism-based trials addressing aspects of the underlying pathophysiology of Alzheimer's disease. AD is multi-dimensional in nature, characterized not only by cognitive and functional decline but by neuropsychiatric symptoms that develop commonly and are associated with considerable morbidity...
December 7, 2002: Advanced Drug Delivery Reviews
Tiffany W Chow, Mario F Mendez
This review ofpharmacotherapyforfrontotemporal lobar degeneration describes the chemical rationale for agents used and reports observed responses to psychotropic medications. Paroxetine addressed anxiety and repetitive, ritualistic behaviors. Depression was resistant to treatment. Valproic acid and quetiapine calmed agitated subjects without exacerbating Parkinsonism. Donepezil has not emerged as a beneficial medication for this group of subjects. Behavioral disturbances can be alleviatedpharmacologically, but further research might determine guidelines for management of this non-Alzheimer's dementia syndrome that could decrease the frequency of adverse drug events...
September 2002: American Journal of Alzheimer's Disease and Other Dementias
W T Regenold, M Prasad
The authors describe the use of intravenous sodium valproate (Depacon) to treat three geriatric inpatients: two acutely manic patients who refused oral medication and one dementia patient with agitation and dysphagia receiving end-of-life care for Alzheimer's disease.
2001: American Journal of Geriatric Psychiatry
G Stoppe, J Staedt
Behavioral disorders in dementia are common and are the most important symptoms with regard to socio-economic burden. Up to now there is no common international agreement of how to define and measure these disorders. Antidementia trials focus mainly on cognition. Investigations of neurobiological corrolaries of disturbed behavior in the dementias are rare. The same holds true for studies on the longitudinal course of behavioral disorders and their interrelation. Many symptoms may be the expression of variable conditions, e...
June 1999: Zeitschrift Für Gerontologie und Geriatrie
M A Raskind
Aggression is common in elderly patients with dementia and often leads to placement of these patients in long-term care facilities. Unfortunately, identification and evaluation of aggression is sometimes hindered by disagreement as to how aggression is distinguished from agitation. Aggression in elderly patients with dementia is best understood as a product of the interaction of neurobiological, cognitive, and environmental factors. Such a complex etiology calls for an approach to treatment that considers pharmacologic therapy as well as environmental manipulation; however, further research is needed to clarify the causes of aggression in elderly patients with dementia and thus allow the refinement of approaches to treatment...
1999: Journal of Clinical Psychiatry
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