An Open Pilot Study of Citalopram for Behavioral Disturbances of Dementia Plasma Levels and Real-Time Observations
Citalopram, in European studies, has shown some early promise for treatment of poststroke depression and behavioral complications of dementia. An open pilot study of citalopram was conducted in 16 patients with dementia and behavioral disturbances. Citalopram was well tolerated by 13 of the patients, and 9 had a clinically impressive response. A significant overall mean reduction in disruptive vocalizations was observed by means of a novel technique of computer-assisted real-time observation. The mean citalopram plasma level-to-dose ratio was found to be twice that previously reported in younger patients. These pilot findings should encourage future placebo concentration-controlled trials.
Available from: Patricia R Houck
- "Evidence to support the use of alternative agents remains scarce. Our group has reported on the efficacy of the selective serotonin reuptake inhibitor (SSRI) citalopram in one open (Pollock et al., 1997) and two double-blind randomized trials: one placebo-controlled (Pollock et al., 2002) and one with risperidone as the active comparator (Pollock et al., 2007). However, the clinical utility of SSRIs has yet to be confirmed. "
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ABSTRACT: The risk/benefit ratio of pharmacotherapy for behavioral symptoms of dementia is questionable: second-generation antipsychotics are poorly tolerated, and the efficacy of alternative treatments, for example, selective serotonin-reuptake inhibitors (SSRIs), is uncertain. Biomarkers of treatment response may improve this risk/benefit ratio. The length polymorphism of the serotonin transporter promoter gene (5-HTTLPR/SLC6A4) may moderate tolerability of SSRIs and expression of behavioral symptoms in dementia. We assessed the effect of 5-HTTLPR on tolerability and efficacy of citalopram and risperidone in a 12-week randomized controlled trial, which included nondepressed patients with dementia hospitalized for behavioral or psychotic symptoms. Genotypes including the A/G polymorphism of the L allele (rs25531) were determined in 92 of 103 participants. We used pattern-mixture models to account for dropout. Low-expression alleles (S and Lg) predicted greater early and overall side effects of citalopram and early treatment discontinuation. These results remained unchanged after excluding African-American participants and in covariate analyses. Unexpectedly, low-expression alleles seemed to predict greater early side effects of risperidone (but not early discontinuation) and poorer early response of psychosis symptoms to risperidone. In conclusion, 5-HTTLPR may be a useful biomarker of SSRI intolerance in dementia. Our findings of intolerance of a second-generation antipsychotics and persistence of psychosis in patients with low-expression alleles needs to be replicated.
Available from: Sibel Cakir
- "There are some reports showed serotoninergic psychotropic agents like trazadone, citalopram, or paroksetin could be useful in treatment of agitation (Pollock et al 1997; Ramadan 2000). In our opinion, mirtazapine could make a step forward for previously studied agents. "
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ABSTRACT: Agitation is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of agitated patients with Alzheimer's disease (AD). The consecutive patients with AD who have significant agitation were assigned to a 12-week open-label, prospective study. Patients received mirtazapine 15-30 mg/day. The changes in Cohen-Mansfield Agitation Inventory-Short form (CMAI-SF) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirteen of 16 (81.25%) patients completed the study. There was a significant reduction in CMAI-SF and CGI-S between the pre- and post-treatment with mirtzapaine (p < 0.001). The mean baseline score was 26.54 ( +/- 5.4) and mean reduction was 10.6 ( +/- 7.5) in CMAI-SF. There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of agitated patients with AD.
Available from: Kimberly Van Haitsma
- "Construct validity was demonstrated in the dementia population through sensitivity of positive behaviors to a video-respite intervention. The Computer-Assisted Data Collection (Burgio et al., 1994; Holm, Rogers, Burgio, & McDowell, 1999; Pollock et al., 1997; Rogers et al., 1999) focuses on the effects of multiple environmental factors, including staff behavior, on resident behavior. A laptop computer is used to record the frequency and duration of disruptive vocalizations, duration of activities of daily living (ADLs), number of caregiver assists, requests for help, and variables identifying environmental context. "
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ABSTRACT: This review article reports on methods of direct observation of behaviors for use in long-term care settings, particularly with older adults who have dementia. This article provides information on the theoretical roots, administration methods, and psychometric properties of measures of direct observation of individual behavior. It is hoped that this review will help gerontological nurses make informed choices about the direct observation measures that suit their specific needs, highlight the role of direct observation in quality improvement for dementia care, and facilitate a balance between identifying a gold standard and allowing flexibility to assess project-specific behaviors.
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