Valproic Acid in Dementia

Dolder, Christian R.; Nealy, Kimberly L.; McKinsey, Jonathan

doi:10.1177/0897190011424802

Cited by 13 publications

(4 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Agitation in DLB often needs to be managed with low doses of atypical antipsychotic drugs [38, 47], but the dose may be limited due to motor side effects. Recent studies have shown that low doses of valproic acid (or divalproex) can be used as an adjunct to drugs like quetiapine in managing the agitation of DLB [49, 50, 52, 53]. Pimavanserin is approved by the FDA for treating psychosis in PD, but it also needs to be tested in DLB patients who are experiencing hallucinations and delusions [41].…”

Section: Resultsmentioning

confidence: 99%

“…The patient improved, however, when a low dosage of divalproex (250 mg twice daily) was added as adjunctive therapy. Others have shown valproic acid to be effective as an adjunct to low doses of atypical antipsychotic drugs in managing the agitation associated with various dementing illnesses [50]. A systematic review performed by the Cochrane Database demonstrated that valproic acid (or divalproex) does not appear to be as useful for managing agitation in dementia patients when it is prescribed as monotherapy [51].…”

Section: Treatments For Fluctuations and Agitation In Dlbmentioning

confidence: 99%

See 1 more Smart Citation

Pharmacological Management of Dementia with Lewy Bodies

Hershey

Coleman-Jackson

2019

Drugs Aging

View full text Add to dashboard Cite

Dementia with Lewy bodies (DLB) is a complex disease that involves a variety of cognitive, behavioral and neurological symptoms, including progressive memory loss, visual hallucinations, parkinsonism, cognitive fluctuations and rapid eye movement sleep behavior disorder (RBD). These symptoms may appear in varying combinations and levels of severity in each patient who is seen in the clinic, making diagnosis and treatment a challenge. DLB is the third most common of all the neurodegenerative diseases behind both Alzheimer’s disease and Parkinson’s disease (PD). The median age of onset for DLB (76.3 years) is younger than that seen in PD dementia (81.4 years). New pathological studies have shown that most DLB patients have variable amounts of Alzheimer’s changes in their brains, explaining the wide variability in this disease’s clinical presentation and clinical course. This review discusses the three cholinesterase inhibitors that have been shown to be effective in managing the cognitive and behavioral symptoms of DLB: rivastigmine, galantamine and donepezil. Memantine is able to improve clinical global impression of change in those with mild to moderate DLB. Levodopa can treat the parkinsonism of some DLB patients, but the dose is often limited due to the fact that it can cause agitation or worsening of visual hallucinations. A recent phase 2 clinical trial showed the benefit of zonisamide when it is added as an adjunct to levodopa for treating DLB parkinsonism. While atypical antipsychotic drugs may not always be helpful as monotherapy in managing the agitation associated with DLB, low doses of valproic acid can be effective when added as an adjunct to drugs like quetiapine. Pimavanserin may prove to be a useful treatment for psychosis in DLB patients, but like other antipsychotic drugs that are used in dementia patients, there is a small increased risk of mortality. RBD, which is a common core clinical feature of DLB, can be managed with either melatonin or clonazepam. Two agents targeting alpha-synuclein (NPT200-11 and ambroxol) currently hold promise as disease-modifying therapies for DLB, but they are yet to be tested in clinical trials. An agent (E2027) that offers hope of neuroprotection by increasing central cyclic guanosine monophosphate (cGMP) levels is currently being examined in clinical trials in DLB patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Treatments For Fluctuations and Agitation In Dlbmentioning

confidence: 99%

Pharmacological Management of Dementia with Lewy Bodies

Hershey

Coleman-Jackson

2019

Drugs Aging

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…[3] Meanwhile, evidence-based treatment guidelines for dementia suggest that anticonvulsants are not recommended in general, but state that in some patients, we could take them into consideration. [4] Although not permitted, several drugs are still used in clinical practice for the treatment of PwD, one of the most commonly prescribed is the newer atypical antipsychotic agents; however, studies have shown that these drugs may increase the risk of stroke and death in PwD. Benzodiazepines, a common first-line treatment, have been associated with the risk of falls and disinhibition, which may increase agitation and aggression.…”

Section: Introductionmentioning

confidence: 99%

Effects of magnesium valproate adjuvant therapy on patients with dementia: A systematic review and meta-analysis

Zhang¹,

Sun²,

Sun

2022

Medicine

View full text Add to dashboard Cite

Background: Current research has found contradictory results on the treatment of magnesium valproate (VPM) in patients with dementia (PwD).Objectives: Here, we conducted a meta-analysis to evaluate the efficacy and safety of VPM in the adjuvant treatment of PwD.Purpose: Current research has found contradictory results on the treatment of VPM in PwD. Here, we conducted a metaanalysis to evaluate the efficacy and safety of VPM in the adjuvant treatment of PwD.Methods: MEDLINE via PubMed, Cochrane Library, EBSCO, Embase, China National Knowledge (CNKI), and Wan Fang databases were researched to gather relevant data on magnesium valproate assistant therapy for patients with dementia (PwD) by using medical subject headings and term words.Results: After the final screening, 22 RCT studies (a total of 1899 participants) were included in this meta-analysis, which compared VPM adjuvant treatment with antidementia or psychotropic drug monotherapy. Significant differences were found in the scores on mini-mental state examination (P = .028), Alzheimer disease assessment scale cognitive subscale (P < .05), Bech-Rafaelsen Mania Rating Scale (P < .05), behavioral pathology in Alzheimer disease rating scale (P = .001), activities of daily living (P < .05), and Pittsburgh Sleep Quality Index (P < .05). Besides, the levels of inflammatory factors including IL-1β, IL-6, and TNF-α were significantly lower than those in the monotherapy group (P < .05). While there was no increase in the incidence of adverse events (P = .383), VPM as an assistant therapy is generally well tolerated in PwD. Conclusion:By meta-analysis, evidence was found to support VPM additional used for the treatment of cognitive function, psychiatric symptoms, or disease improvement in PwD. VPM may be a potential drug to aid in the treatment of dementia patients. However, there was lack of enough evidence to classification of dementia severity in our inclusion study. More research is still needed, including clinical trials evaluating VPM as a complementary therapy.

show abstract

Prescribing in Older People

2021

The Maudsley Prescribing Guidelines in Psychiatry

View full text Add to dashboard Cite

The pharmacokinetics and pharmacodynamics of most drugs are altered to an important extent in older people. Older people often have a number of concurrent illnesses and may require treatment with several drugs. Older people may be more prone to develop serious adverse effects such as agranulocytosis and neutropenia with clozapine, stroke with antipsychotic drugs and bleeding with selective serotonin reuptake inhibitors. This chapter summarizes guidance for discontinuation of dementia medication in clinical practice. People with dementia are more susceptible to cognitive side effects of drugs. Medications prescribed for physical disorders may interact with cognitive‐enhancing medication. The evidence for efficacy of antidepressants in behavioural and psychological symptoms of dementia is mixed and limited showing that antidepressants are most helpful for treating agitation and less so for depression, apathy, anxiety or psychosis in dementia. The chapter deals with covert medication provision within UK law only. In mental health settings it is common for patients to refuse medication.

show abstract

Valproic Acid in Dementia

Cited by 13 publications

References 54 publications

Pharmacological Management of Dementia with Lewy Bodies

Pharmacological Management of Dementia with Lewy Bodies

Effects of magnesium valproate adjuvant therapy on patients with dementia: A systematic review and meta-analysis

Prescribing in Older People

Contact Info

Product

Resources

About