A Double-Blind Comparison of Citalopram and Risperidone for the Treatment of Behavioral and Psychotic Symptoms Associated With Dementia

Pollock, Bruce G.; Mulsant, Benoit H.; Rosen, Jules; Mazumdar, Sati; Blakesley, Richard E.; Houck, Patricia R.; Huber, Kimberly

doi:10.1097/jgp.0b013e3180cc1ff5

Cited by 240 publications

(140 citation statements)

References 32 publications

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“…A recent clinical trial demonstrated the efficacy of citalopram in treating the psychosis of dementia, further implicating serotonergic mechanisms [50].…”

Section: Discussionmentioning

confidence: 99%

Neurobiology of Delusions in Alzheimer’s Disease

Ismail

Nguyen

Fischer

et al. 2011

Curr Psychiatry Rep

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Alzheimer's disease (AD) is associated with cognitive and functional impairment as well as neuropsychiatric sequelae, including psychotic symptoms such as delusions and hallucinations. Strong evidence supports the need to study delusions separate from hallucinations. Integrating the epidemiology, clinical correlates, and neuropathological and genetic literature for delusions in AD allows us to speculate on etiology and mechanisms. Plaque and tangle deposition in individuals with susceptible alleles of serotonergic, muscarinic, nicotinic, or Apoε4 genes appears to result in disruption of cortical circuitry, culminating in delusions. While delusions in AD correspond to a phenotype distinct from AD without delusions, subtypes of delusions may also define further distinct clinical entities.Persecutory delusions may occur earlier in the illness and have a more significant genetic component than misidentification delusions, which are associated with increased cognitive impairment and advanced dementia. Clearly distinguishing between these two syndromes is essential to making progress in the area of delusions in AD.

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“…A recent clinical trial demonstrated the efficacy of citalopram in treating the psychosis of dementia, further implicating serotonergic mechanisms [50].…”

Section: Discussionmentioning

confidence: 99%

Neurobiology of Delusions in Alzheimer’s Disease

Ismail

Nguyen

Fischer

et al. 2011

Curr Psychiatry Rep

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“…Nevertheless, four other studies reported that antidepressants were not more effective than a placebo for NPS (Auchus and Bissey-Black, 1997;Teri et al, 2000;Lyketsos et al, 2003;Finkel et al, 2004), and a review concluded that antidepressants were not very effective in the treatment of NPS (Seitz et al, 2011). Two studies have reported similar effects for citalopram as for risperidone in reducing agitation and psychosis in patients with dementia (Pollock et al, 2007;Barak et al, 2011). The side effects of antidepressants vary between the classes of antidepressants.…”

Section: Antidepressive Medicationmentioning

confidence: 99%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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ObjectiveThe Severe Impairment Battery (SIB) is developed to test cognitive function in patients with dementia of moderate to severe degree. We have conducted a study to assess the inter‐rater reliability and the validity of the Norwegian version of SIB.MethodsThe reliability study comprised 30 patients, and the validity study 59 patients in nursing homes. We assessed Cronbach's alpha coefficient of the scale and the inter‐rater reliability for the total SIB score and its nine sub scores between two testers by means of the Spearman's correlation coefficients. In the validity study we compared the SIB scores with the scores on the Clinical Dementia Rating Scale.ResultsThe mean SIB score was 72.10 (SD 25.37). The Cronbach's alpha was 0.97, and the inter‐rater reliability of total SIB score was Spearman's rho 0.85, and ranged from 0.46 to 0.76 for the nine sub‐scores. The mean SIB score for patients with a CDR score < 2 was 84.2(13.4), whereas total scores for patients with CDR 2 and 3 were 74 (18.9) and 48.4 (33.3), respectively. A cut‐off point of 80.5 points gave the highest accuracy in discriminating between patients with CDR 2 and CDR 3, while a cut‐off point of 87.5 best discriminated between CDR < 2 and CDR 3.ConclusionThe study indicates that the Norwegian version of SIB is a reliable and valid test with which to evaluate the cognition in patients with dementia of moderate to severe degree. Copyright © 2008 John Wiley & Sons, Ltd.

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“…Studies have demonstrated benefits for agitation with citalopram compared with placebo 76 and similar efficacy compared with risperidone. 77 …”

Section: Tricyclic Antidepressant Agentsmentioning

confidence: 99%

Guidelines for the Management of Cognitive and Behavioral Problems in Dementia

Sadowsky¹,

Galvin²

2012

The Journal of the American Board of Family Medicine

116

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Family physicians play a crucial role in the management and ongoing care of patients with Alzheimer disease (AD). This article reviews the effects of nonpharmacologic and pharmacologic interventions on the functional abilities and behavior of patients with dementia and how these can be implemented into clinical practice. Nonpharmacologic interventions are recommended as the initial strategy for managing problematic behaviors. Strategies for improving behavior include ensuring that the patient's environment is safe, calm, and predictable; removing environmental stressors; and identifying and avoiding situations that agitate or frighten the patient. Simple interventions include redirecting and refocusing the patient, increasing social interaction, establishing regular sleep habits, eliminating sources of conflict and frustration, and establishing rewards for successes. The effectiveness of long-term behavioral management is largely dependent on the caregiver; as such, it is important to assess the role and needs of the caregiver.Because currently available therapies cannot reverse the pathologic processes of AD, the primary objective of pharmacotherapy is to preserve cognitive and functional ability, minimize behavioral disturbances, and slow disease progression. Cholinesterase inhibitors represent first-line therapy for patients with mild to moderate AD, whereas a glutamate N-methyl D-aspartate antagonist is used in the treatment of moderate to severe AD. Looking forward, there are a number of therapies in development aimed at modifying the disease course; these include amyloid-lowering drugs, -based and neuroprotective approaches, acetylcholine agonists, and mitochondrial inhibitors.

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A Double-Blind Comparison of Citalopram and Risperidone for the Treatment of Behavioral and Psychotic Symptoms Associated With Dementia

Cited by 240 publications

References 32 publications

Neurobiology of Delusions in Alzheimer’s Disease

Neurobiology of Delusions in Alzheimer’s Disease

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Guidelines for the Management of Cognitive and Behavioral Problems in Dementia

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