Anticonvulsants in the treatment of aggression in the demented elderly : an update

  • Introduction Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. Methods Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. Results To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. Conclusions So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.

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Author:Benedikt Amann, Johannes Pantel, Heinz Grunze, Eduard Vieta, Francesc Colom, Ana Gonzalez-Pinto, Dieter Naber, Harald Hampel
URN:urn:nbn:de:hebis:30-64317
DOI:https://doi.org/10.1186/1745-0179-5-14
ISSN:1745-0179
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/19531220
Parent Title (English):Clinical practice and epidemiology in mental health
Publisher:BioMed Central
Place of publication:London
Document Type:Article
Language:English
Date of Publication (online):2009/07/02
Date of first Publication:2009/06/16
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2009/07/02
Volume:5
Issue:14
Page Number:8
First Page:1
Last Page:8
Note:
© 2009 Amann et al., licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Source:Clinical Practice and Epidemiology in Mental Health 2009, 5:14 ; doi:10.1186/1745-0179-5-14 ; http://www.cpementalhealth.com/content/5/1/14
HeBIS-PPN:213743876
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 2.0