Treating Neuropsychiatric Symptoms in Dementia With Lewy Bodies

Abstract

Sensitivity to psychotropic medications presents a therapeutic challenge when treating neuropsychiatric symptoms in patients with dementia with Lewy bodies (DLB). We compared under randomized, double-blinded conditions the tolerability and efficacy of citalopram and risperidone in the treatment of behavioral and psychotic symptoms in patients with DLB and Alzheimer disease (AD). Thirty-one participants with DLB and 66 with AD hospitalized for behavioral disturbance were treated under randomized, double-blind conditions with citalopram or risperidone for up to 12 weeks. Neuropsychiatric symptoms were assessed with the nursing home version of the Neuropsychiatric Inventory (NPI) and the Clinical Global Impression of Change (CGIC). Side effects were measured using the UKU Side Effect Rating Scale. A significantly higher proportion of participants with DLB (68%) than with AD (50%) discontinued the study prematurely. Discontinuation rates were comparable in DLB participants treated with citalopram (71%) or risperidone (65%). However, participants with DLB randomized to risperidone experienced a higher overall burden of side effects. Scores on the NPI and the CGIC worsened in DLB participants and improved in those with AD. Most patients with behavioral disturbances or psychosis associated with DLB tolerate citalopram or risperidone poorly and do not seem to benefit from either medication.

Incidence and predictive factors of depressive symptoms in Alzheimer's disease: The REAL.FR study

“…it is possible that the value of the time-dependent predictive variable could have changed during this period, in particular bpsd which fluctuate in Ad. however, the follow-up visits of Ad patients usually take place at intervals of several months, and six-monthly visits are recommended (72). the results we present are therefore relevant for a clinician following this care plan.…”

Pharmacological Management of Lewy Body Dementia: A Systematic Review and Meta-Analysis

“…The highest level of evidence for antidepressants was from a randomized trial of citalopram in DLB (51) and an unpublished trial of duloxetine, escitalopram, and trazodone in PDD (52). Citalopram does not appear to be efficacious or well tolerated in DLB, with 10 of 14 participants (71.4%) withdrawing because of adverse effects (51).…”

“…No side effects were reported. In DLB, risperidone does not appear to be well tolerated; results of a randomized controlled trial (N531) suggest deterioration in cognition (MMSE change, 22.3 points), worsening psychiatric symptoms (NPI change, 17.3 points), and study withdrawal (65%) (51).…”

“…The highest level of evidence for risperidone was from a randomized trial in DLB and an uncontrolled trial in Parkinson's disease dementia (50,51). In participants with PDD and psychosis (N59) significant reductions were observed in Brief Psychiatric Rating Scale score (29.5 points) and Cohen-Mansfield Agitation Inventory score (29.6 points), and improvements were seen in social, occupational, and psychological functioning (Global Assessment of Functioning change, 17 points) (50).…”

Psychosis in Later Life

“…Two included patients with Alzheimer's disease, 126,127 and the other included patients with either Alzheimer's disease or Lewy body dementia. 128 Two of the studies compared citalopram 128 or escitalopram 126 to risperidone, and neither study found a significant difference between groups. Barak and colleagues 126 report, however, that symptoms did significantly improve in both treatment groups over time.…”