Cognitive effects of anticonvulsant monotherapy in elderly patients: a placebo-controlled study

Read, Carol L.; Stephen, Linda J.; Stolarek, Iwona; Paul, Audrey; Sills, Graeme J.; Brodie, Martin J.

doi:10.1016/s1059-1311(98)80073-3

Cited by 38 publications

(4 citation statements)

References 23 publications

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“…The cognitive side effects of AEDs do not develop only at higher doses: there is indeed no significant correlation between dose and cognitive impairment for PHT in a large cohort study (19) and nor for VPA (20,21). This is in accordance with the finding that, generally, side effects of VPA are not related to dose or serum level (22).…”

Section: The Cognitive Effects Of Commonly Used Drugssupporting

confidence: 77%

Effects of Antiepileptic Drugs on Cognition

Aldenkamp

2001

Epilepsia

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Section: The Cognitive Effects Of Commonly Used Drugssupporting

confidence: 77%

Effects of Antiepileptic Drugs on Cognition

Aldenkamp

2001

Epilepsia

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“…The central aim of this study was to examine differential cognitive effects of GBP and CBZ. Previous attention to potential neuropsychological effects of AEDs in seniors has been limited and has compared only more traditional AEDs (4,11). This study demonstrated that for the 11 cognitive variables, only a single measure of attention was statistically different between the two AEDs.…”

Section: Discussionmentioning

confidence: 73%

“…Sparse effort has been directed to the study of the potential cognitive effects of CBZ in senior adults despite its widespread clinical use for chronic seizures and other conditions. Read et al (11) recently found no significant changes in various cognitive task performances in senior adults who took an extra dose of their AED medication (either CBZ, VPA, or PHT). They concluded that cognitive impairment does not develop when modest dose increases are given in patients taking therapeutic monotherapy AED.…”

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confidence: 99%

Comparative Cognitive Effects of Carbamazepine and Gabapentin in Healthy Senior Adults

et al. 2001

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Summary:Purpose: This study compared the cognitive effects of carbamazepine (CBZ) and gabapentin (GBP) in healthy senior adults by using a randomized, double-blind crossover design.Methods: Thirty-four senior adults were randomized to receive one of the two drugs followed by a 5-week treatment period. A 4-week washout phase preceded initiation of the second drug. Antiepileptic drugs (AEDs) were titrated to target doses of either CBZ (800 mg/day) or GBP (2,400 mg/day). Primary outcome measures were standardized neuropsychological tests of attention/vigilance, psychomotor speed, motor speed, verbal and visual memory, and the Profile of Mood State (POMS), yielding a total of 17 variables. Each subject received cognitive testing at predrug baseline, end of first drug phase, end of second drug phase, and 4 weeks after completion of the second drug phase.Results: Fifteen senior adults (mean age, 66.5 years; range, 59-76 years) completed the study. Seniors completing the study did not differ significantly from noncompleting seniors in terms of demographic features or baseline cognitive performances. Fifteen of the 19 seniors not completing the study dropped out while receiving CBZ. Adverse events were frequently reported for both AEDs, although they were more common for CBZ. Mean serum levels for the completers were within midrange clinical doses (CBZ, 6.8 g/ml; GBP, 7.1 g/ml). Significant differences between CBZ and GBP were found for only one of 11 cognitive variables, with better attention/vigilance for GBP, although the effect was modest. Performances on the nondrug average were significantly better on 45% of cognitive variables compared with CBZ and 36% compared with GBP. The overall pattern of means favored GBP over CBZ on 15 of 17 (p < 0.001), nondrug over CBZ on 17 of 17 (p < 0.0000), and nondrug over GBP on eight of 17 (NS).Conclusions: Mild cognitive effects were found for both AEDs compared with the nondrug average condition. The magnitude of difference between the two AEDs across the cognitive variables was modest. Self-reported mood was not significantly affected by either AED. However, overall tolerability and sideeffect profile of CBZ were poorer than those of GBP in senior adults at doses and titration rates reported in this study. Key Words: Carbamazepine-Gabapentin-Cognition-MoodSenior adults.Epidemiologic estimates indicate that the incidence of epilepsy in senior adults has increased over the past several decades, with annual estimates of new epilepsy cases in those older than 60 years approaching 45-50,000 in the United States (1). The prevalence rate of active epilepsy in persons older than 60 years now approaches 1% (2). Treatment for senior adults with epilepsy has relied on the incorporation of studies on younger patients that do not fully account for the complex physiologic and pharmacokinetic changes that occur with aging (3). This complexity makes an already difficult treatment selection even more so, when considering the range of medication side effects and interactions that are more proble...

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“…Most of the published sources extrapolate treatment recommendations from experience in the general epilepsy population, either refer to retrospective case series pooled from different studies, or limit data to pharmacokinetics, drug exposure and/or tolerability (1,(9)(10)(11)(12)(13)(14)(15)(16). Trials for registration purposes often exclude elderly patients.…”

mentioning

confidence: 99%