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With recent safety warnings associated
with medications for behavioural and psychological symptoms
of dementia (BPSD), more attention has been focused on non-pharmacological
approaches. In a small controlled trial, 40 patients with AD
were randomized to receive either psychodynamic interpersonal
therapy or standard care (Burns et al ). Unfortunately,
none of the patient outcome measures, including depression scores,
differed between groups following treatment. While this was
a well designed trial, an excellent systematic review of psychological
approaches for the management of BPSD emphasized how few rigorous
trials exist (Livingston et al ). Only behavioural management
for symptoms of depression, some types of caregiver and staff
education, and possibly cognitive stimulation have demonstrated
lasting benefits.
Brief psychotherapy in Alzheimer’s
disease:
randomised controlled trial
(BRIT J PSYCHIATRY 2005;187:143-147)
ALISTAIR BURNS,
ELSE GUTHRIE,
FEDERICA MARINO-FRANCIS,
CHARLOTTE BUSBY,
ET AL,
MANCHESTER, UK
Systematic review of psychological
approaches to the management of neuropsychiatric symptoms of
dementia
(AM J PSYCHIATRY 2005;162:1996-2021)
GILL LIVINGSTON, MD,
FRCPSYCH,
KATE JONSTON, MSC,
CORNELIUS KATONA, MD,
FRCPSYCH,
JONI PATON, BSC,
ET AL,
LONDON, UK
OLD AGE TASK FORCE OF
THE WORLD FEDERATION
OF BIOLOGICAL PSYCHIATRY
VALPROATE IS NOT EFFECTIVE
FOR AGITATION IN AD
While three previous randomized controlled
trials (RCTs) failed to demonstrate any benefit for valproate
on primary outcome measures, some secondary measures of agitation
improved in these trials. A recent study by Tariot et al
was designed to once again test whether valproate had any
benefit in the treatment of agitation in AD. In this fairly
large, placebo-controlled trial, valproate was not better than
placebo on any of the primary or secondary measures. With this
fourth negative study, it appears that use of valproate for
BPSD cannot be recommended.
Divalproex sodium in nursing home
residents with possible or probable Alzheimer disease complicated
by agitation: a randomized, controlled trial
(AM J GERIATR PSYCHIATRY 2005;13:942-949)
PIERRE N. TARIOT, MD,
REMA RAMAN, PHD,
LAURA JAKIMOVICH, RN, MS,
LON SCHNEIDER, MD,
ET AL,
FOR THE ALZHEIMER’S DISEASE
COOPERATIVE STUDY/VALPROATE
NURSING HOME STUDY GROUP,
VARIOUS CENTRES, USA
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