Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: An update review

Abstract

Behavioral and psychological symptoms of dementia (BPSD) are common and debilitating problems, but current treatments are limited. Antipsychotic agents show some efficacy on BPSD, but their use is limited by the associated risk of cerebrovascular events and mortality. Reports have shown the efficacy of mood stabilizers on BPSD, but systemic reviews on this issue are scant. This article aims to review studies of the efficacy of mood stabilizers on BPSD, and the quality of the available evidence. We searched for articles published in English during the period 1990 to 2010 and included in the PubMed database that concerned treatment of BPSD with mood stabilizers, such as carbamazepine, valproate, gabapentin, topiramate, lamotrigine, oxcarbazepine and lithium. The quality of the studies was assessed by considering the trial designs, analyses, subjects and results. We found one meta-analysis and three randomized controlled trials (RCTs) supporting the efficacy of carbamazepine in managing global BPSD, particularly aggression and hostility. With regard to valproate, current evidence from one meta-analysis and five RCTs did not strongly support its efficacy for global BPSD, including agitation and aggression. Only open trials or case series showed some efficacy of gabapentin, topiramate and lamotrigine in controlling BPSD. The single RCT investigating the effect of oxcarbazepine on agitation and aggression showed negative results. Case series reports on lithium tended to show it to be ineffective. Thus far, among mood stabilizers, carbamazepine has the most robust evidence of efficacy on BPSD. More RCTs are needed to strengthen evidence regarding the efficacy of gabapentin, topiramate and lamotrigine. Valproate, oxcarbazepine and lithium showed low or no evidence of efficacy. Large and well designed RCTs focusing on specific symptoms of BPSD are needed to deal with the issue.

Pharmacological management of behavioural and psychological symptoms of dementia

“…Two of three trials utilising carbamazepine in the treatment of BPSD suggested improved outcomes . Concerns regarding the tolerability of carbamazepine limit its use.…”

“…Reviews have failed to find evidence that valproate helps BPSD . One trial revealed poorer behavioural outcomes, and almost all reported more adverse events in the treatment groups …”

Pharmacological Treatment of the Behavioral and Psychological Symptoms of Dementia

“…(Note that, although valproic acid [Depakote] and other anticonvulsant mood stabilizers are sometimes used, there are currently little or no data supporting their use and we do not recommend using anticonvulsants in this setting [for review see Yeh & Ouyang, 2012]. (Note that, although valproic acid [Depakote] and other anticonvulsant mood stabilizers are sometimes used, there are currently little or no data supporting their use and we do not recommend using anticonvulsants in this setting [for review see Yeh & Ouyang, 2012].…”

Preventing falls in In-Patient Older Adult Mental Health Services: Different Causative Factors in Mental and Neurocognitive Disorders

“…Although there is some literature that suggests that Sodium Valproate is helpful in treating BPSD [50], recent reviews question the efficacy and tolerability of Sodium Valproate in BPSD [51]. Konovalov, Muralee [52] suggest that anticonvulsant mood stabilizers should not be recommended for routine use in the treatment of BPSD citing that of 7 RCTs of anticonvulsant therapy in BPSD published only one showed significant improvement compared to placebo, while five showed no statistical difference and one showed significant worsening of BPSD in the treatment group compared to placebo.…”