Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-20T05:24:12.412Z Has data issue: false hasContentIssue false
  • English
  • Français

Escitalopram versus risperidone for the treatment of behavioral and psychotic symptoms associated with Alzheimer's disease: a randomized double-blind pilot study

Published online by Cambridge University Press:  15 April 2011

Yoram Barak ,
Igor Plopski ,
Shelly Tadger  and
Diana Paleacu
Yoram Barak*
Affiliation:
Abarbanel Mental Health Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
Igor Plopski
Affiliation:
Abarbanel Mental Health Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
Shelly Tadger
Affiliation:
Abarbanel Mental Health Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
Diana Paleacu
Affiliation:
Abarbanel Mental Health Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
*
Correspondence should be addressed to: Yoram Barak, MD, MHA, Director of Psychogeriatrics, Abarbanel MHC, 15 KKL Street, Bat-Yam, 59100, Israel. Phone and Fax: +972-3-5552738. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Antipsychotics are frequently used to treat psychosis, aggression and agitation in patients with Alzheimer's disease (AD), but safety warnings abound. Escitalopram was investigated since citalopram has demonstrated some effectiveness in AD. We compared escitalopram and risperidone for psychotic symptoms and agitation associated with AD.

Methods: Inpatients with AD, who had been hospitalized because of behavioral symptoms, were recruited to a six-week randomized, double-blind, controlled trial. Participants (n = 40) were randomized to once daily risperidone 1 mg or escitalopram 10 mg.

Results: The NPI total score improved in both groups. Onset was earlier in the risperidone-treated group, but improvement did not significantly differ between groups by study end. Completion rates differed for escitalopram (75%) and risperidone (55%), mainly due to adverse events. There were no adverse events in the escitalopram group, while in the risperidone group two patients suffered severe extrapyramidal symptoms and four patients suffered acute physical illness necessitating transfer to general hospital.

Conclusion: Escitalopram and risperidone did not differ in efficacy in reducing psychotic symptoms and agitation in patients with AD. Completion rates were higher for escitalopram-treated patients. Replication in larger trials with ambulatory patients is needed.

Keywords

Alzheimer's diseasepsychosisescitalopramrisperidone
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 9 , November 2011 , pp. 1515 - 1519
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballard, C. and Howard, R. (2006). Neuroleptic drugs in dementia: benefits and harm. Nature Reviews Neuroscience, 7, 492–500.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Food and Drug Administration (2005). FDA Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. 11 April. Available at: http://www.fda.gov/cder/drug/advisory/antipsychotics.htm.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gorwood, P., Weiller, E., Lemming, O. and Katona, C. (2007). Escitalopram prevents relapse in older patients with major depressive disorder. American Journal of Geriatric Psychiatry, 15, 581–593.CrossRefGoogle ScholarPubMed
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Mnie-Filali, O. et al. (2007). R-citalopram prevents the neuronal adaptive changes induced by escitalopram. Neuroreport, 18, 1553–1556.CrossRefGoogle ScholarPubMed
Nyth, A. L. and Gottfries, C. G. (1990). The clinical efficacy of citalopram in treatment of emotional disturbances of dementia disorders: a Nordic multicentre study. British Journal of Psychiatry, 157, 894–901.CrossRefGoogle ScholarPubMed
Pollock, B. G. et al. (2002). Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients. American Journal of Psychiatry, 159, 460–465.CrossRefGoogle ScholarPubMed
Pollock, B. G. et al. (2007). A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia. American Journal of GeriatricPsychiatry, 15, 942–952.Google ScholarPubMed
Schneider, L. S. et al. for the CATIE-AD Study Group (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.CrossRefGoogle ScholarPubMed
Seitz, D. P., Adunuri, N., Gill, S. S., Gruneir, A., Herrmann, N. and Rochon, P. (2011). Antidepressants for agitation and psychosis in dementia. Cochrane Database Systemic Reviews, 16, 2:CD008191.Google Scholar
Sweet, R. A. et al. (2001). The 5HTTLPR-polymorphism confers liability to a combined phenotype of psychotic and aggressive behavior in Alzheimer's disease. International Psychogeriatriatrics, 13, 401–409.CrossRefGoogle Scholar
Wu, E., Greenberg, P. E., Yang, E., Yu, A. and Erder, M. H. (2008). Comparison of escitalopram versus citalopram for the treatment of major depressive disorder in a geriatric population. Current Medical Research Opinion, 24, 2587–2595.CrossRefGoogle Scholar