When and How to Treat Agitation in Alzheimer's Disease Dementia With Citalopram and Escitalopram

Aga, Vimal M.

doi:10.1016/j.jagp.2019.04.016

Cited by 13 publications

(11 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, sertraline was demonstrated to decrease agitation or aggressiveness and other psychiatric symptoms, in a double-blind, randomized, placebo-controlled study (111). In particular, AD patients with moderate to severe behavioral symptoms seem to respond to sertraline (156).…”

Section: Alzheimer's Diseasementioning

confidence: 98%

Section: Alzheimer's Diseasementioning

confidence: 99%

“…Moreover, selective serotonin reuptake inhibitors (SSRIs), such as citalopram, escitalopram, and sertraline, have demonstrated efficacy in AD patients (111,156). The use of citalopram is supported by the most compelling evidence for treating AD dementia-related agitation (156). Despite earlier studies not focusing on agitation effects, in the first RCT, citalopram and perphenazine were more effective than placebo in short-term hospital treatments of psychotic disturbances, including agitation (106).…”

Section: Alzheimer's Diseasementioning

confidence: 99%

“…The FDA recommends a maximum daily dose of citalopram of 20 mg/day in patients above the age of 60 (157). Since the effects of citalopram take 2 weeks to ensue, citalopram should not be considered for the acute treatment of agitation (156).…”

Section: Alzheimer's Diseasementioning

confidence: 99%

“…Although risperidone revealed efficacy earlier, the drug produced a higher burden of side effects (110). Since escitalopram may also prolong the QT interval in a dose-dependent manner, a low dose should be considered in the elderly (156). In that respect, the maximum daily dose recommended is 10 mg for patients over 60 (159).…”

Section: Alzheimer's Diseasementioning

confidence: 99%

See 4 more Smart Citations

Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions

et al. 2021

View full text Add to dashboard Cite

Agitation is a behavioral syndrome characterized by increased, often undirected, motor activity, restlessness, aggressiveness, and emotional distress. According to several observations, agitation prevalence ranges from 30 to 50% in Alzheimer's disease, 30% in dementia with Lewy bodies, 40% in frontotemporal dementia, and 40% in vascular dementia (VaD). With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptoms (NPS) in dementia, after apathy and depression, and it is even more frequent (80%) in residents of nursing homes. The pathophysiological mechanism underlying agitation is represented by a frontal lobe dysfunction, mostly involving the anterior cingulate cortex (ACC) and the orbitofrontal cortex (OFC), respectively, meaningful in selecting the salient stimuli and subsequent decision-making and behavioral reactions. Furthermore, increased sensitivity to noradrenergic signaling has been observed, possibly due to a frontal lobe up-regulation of adrenergic receptors, as a reaction to the depletion of noradrenergic neurons within the locus coeruleus (LC). Indeed, LC neurons mainly project toward the OFC and ACC. These observations may explain the abnormal reactivity to weak stimuli and the global arousal found in many patients who have dementia. Furthermore, agitation can be precipitated by several factors, e.g., the sunset or low lighted environments as in the sundown syndrome, hospitalization, the admission to nursing residencies, or changes in pharmacological regimens. In recent days, the global pandemic has increased agitation incidence among dementia patients and generated higher distress levels in patients and caregivers. Hence, given the increasing presence of this condition and its related burden on society and the health system, the present point of view aims at providing an extensive guide to facilitate the identification, prevention, and management of acute and chronic agitation in dementia patients.

show abstract

Section: Alzheimer's Diseasementioning

confidence: 98%