Levetiracetam for agitated Alzheimer's disease patients

Weiner, Myron; Womack, Kyle; Martin-Cook, Kristin; Svetlik, Doris; Hynan, Linda S.

doi:10.1017/s1041610205212061

Cited by 11 publications

(3 citation statements)

References 1 publication

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“…However, whether the effects of these drugs are helpful for long-term control of HIDA domain symptoms is unclear. The evidence for other pharmacological approaches either does not support their use, as is the case for VPA, or is in its infancy, as is the case for AVP-923 (Fhager et al, 2003; Weiner et al, 2005; Birks, 2006; Howard et al, 2007; Kyomen et al, 2007; Ballard et al, 2009; Ng et al, 2009; Rodda et al, 2009; Sommer et al, 2009; Mowla and Pani, 2010; Lockhart et al, 2011; Gallagher and Herrmann, 2014; Cummings et al, 2015; Suzuki and Gen, 2015; Baillon et al, 2018; Kongpakwattana et al, 2018; Sherman et al, 2018; McShane et al, 2019; Supasitthumrong et al, 2019). Overall, substantial improvement is needed to increase the efficacy and reduce the side effects of pharmacotherapies for HIDA domain symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Lamotrigine similarly has low-quality evidence from a retrospective chart review and open-label clinical trial showing that it may reduce agitation in dementia (Ng et al, 2009; Suzuki and Gen, 2015). Results for levetiracetam are mixed across two open-label studies of its effect on agitation and manic-like symptoms in the context of BPSD (Weiner et al, 2005; Kyomen et al, 2007). A retrospective chart review of 15 patients suggested some benefits of topiramate for aggression in dementia (Fhager et al, 2003), and a small RCT of 48 patients suggested a similar benefit of topiramate to risperidone in reducing agitation (Mowla and Pani, 2010).…”

Section: Pharmacological Treatment Approachesmentioning

confidence: 99%

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The Hyperactivity–Impulsivity–Irritiability–Disinhibition–Aggression–Agitation Domain in Alzheimer’s Disease: Current Management and Future Directions

2019

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Behavioral and psychological symptoms of dementia (BPSD) afflict the vast majority of patients with dementia, especially those with Alzheimer’s disease (AD). In clinical settings, patients with BPSD most often do not present with just one symptom. Rather, clusters of symptoms commonly co-occur and can, thus, be grouped into behavioral domains that may ultimately be the result of disruptions in overarching neural circuits. One major BPSD domain routinely identified across patients with AD is the hyperactivity–impulsivity–irritiability–disinhibition–aggression–agitation (HIDA) domain. The HIDA domain represents one of the most difficult sets of symptoms to manage in AD and accounts for much of the burden for caregivers and hospital staff. Although many studies recommend non-pharmacological treatments for HIDA domain symptoms as first-line, they demonstrate little consensus as to what these treatments should be and are often difficult to implement clinically. Certain symptoms within the HIDA domain also do not respond adequately to these treatments, putting patients at risk and necessitating adjunct pharmacological intervention. In this review, we summarize the current literature regarding non-pharmacological and pharmacological interventions for the HIDA domain and provide suggestions for improving treatment. As epigenetic changes due to both aging and AD cause dysfunction in drug-targeted receptors, we propose that HIDA domain treatments could be enhanced by adjunct strategies that modify these epigenetic alterations and, thus, increase efficacy and reduce side effects. To improve the implementation of non-pharmacological approaches in clinical settings, we suggest that issues regarding inadequate resources and guidance for implementation should be addressed. Finally, we propose that increased monitoring of symptom and treatment progression via novel sensor technology and the “DICE” (describe, investigate, create, and evaluate) approach may enhance both pharmacological and non-pharmacological interventions for the HIDA domain.

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Section: Discussionmentioning

confidence: 99%

Section: Pharmacological Treatment Approachesmentioning

confidence: 99%

The Hyperactivity–Impulsivity–Irritiability–Disinhibition–Aggression–Agitation Domain in Alzheimer’s Disease: Current Management and Future Directions

2019

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“…80 In younger people, lamotrigine causes significantly fewer cognitive side-effects than carbamazepine. 84 In the studies of other AEDs in older people, memory problems have not been mentioned as adverse events for carbamazepine, lamotrigine, 33,34 oxcarbazepine 43 or gabapentin. 82 However, cognitive effects were not measured.…”

Section: Cognitionmentioning

confidence: 99%

Antiepileptic drugs for older people

Burbridge

Allen

Vassallo

et al. 2008

Rev. Clin. Gerontol.

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Epilepsy in older people is a common problem. It is estimated that in Europe there are 85 000 new cases of epilepsy annually in those over 65 years old, equivalent to an incidence of 100 per 100 000. Incidence increases with age and the rate in older people is higher than in all but the first year of life. The older population has a median prevalence of 4.7 per 1000 (range 3.0 to 7.3) from nine studies and may be underestimated by case-ascertainment bias common to many studies of older people.

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Current awareness in geriatric psychiatry

2006

Int. J. Geriat. Psychiatry

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Levetiracetam for agitated Alzheimer's disease patients

Cited by 11 publications

References 1 publication

The Hyperactivity–Impulsivity–Irritiability–Disinhibition–Aggression–Agitation Domain in Alzheimer’s Disease: Current Management and Future Directions

The Hyperactivity–Impulsivity–Irritiability–Disinhibition–Aggression–Agitation Domain in Alzheimer’s Disease: Current Management and Future Directions

Antiepileptic drugs for older people

Current awareness in geriatric psychiatry

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