Feburary 18, 2014 | Robert Preidt
"Agitation is one of the worst symptoms for patients and their families: it puts the Alzheimer's patient at risk for other system overloads (cardiac, infection), wears them out physically, and exhausts caregivers and families," noted one expert, Dr. Alan Manevitz, a clinical psychiatrist at Lenox Hill Hospital in New York City.
He said that while antipsychotic drugs are typically used to help ease the agitation, they are also associated with a higher risk of death for Alzheimer's patients, so safer alternatives would be welcome.
The new study was led by Dr. Constantine Lyketsos, director of the Johns Hopkins Memory and Alzheimer's Treatment Center in Baltimore. It included 186 Alzheimer's patients with agitation symptoms such as emotional distress, aggression, irritability, and excessive movement.
Patients taking the drug showed a significant decline in their agitation symptoms and their caregivers reported less stress. In one measure of agitation, about 40 percent of patients taking the antidepressant had "considerable relief," compared with 26 percent of those who took the placebo.
But the drug had risks, too. According to the study, patients taking the antidepressant were more likely to have slightly decreased mental function and abnormal heart function that increases the risk of heart attack.
But antipsychotic medications -- which are currently the first-line treatment for agitation in Alzheimer's patients -- also increase the risk of heart attack, perhaps even more so than citalopram, Lyketsos noted. Antipsychotic drugs also significantly increase the risk of stroke and death. In lower doses than those used in the study, citalopram might be safer than antipsychotic drugs, the researchers concluded.
"If the agitation is not responding to non-medication treatments and your patient's agitation isn't improving, there are no great options," Lyketsos said in a Hopkins news release. "But here's another medication choice that might be safer than other medications and seems to be just as effective."
Manevitz, who was not involved in the study, said each patient's case may be different. "The assessment of 'benefit versus risk' for the use of this or other medications needs to be made by families and physicians together on a 'case by case' basis," he said. "Medications may certainly be necessary in the short term for acute care in many patients and to stabilize the caregiving environment."
Another expert said the Hopkins findings weren't surprising.
"The treatment of the effects of dementia, like depression and agitation, are fraught with their own side effects and therefore are of limited utility for many patients," said Dr. Theodore Strange, a geriatrician and associate chairman of the department of medicine at Staten Island University Hospital, in New York City.
"Citalopram, an antidepressant, has some calming effects on agitation but again needs its own monitoring for side effects," Strange said.
Manevitz also pointed that there are non-drug options that may help calm people with Alzheimer's disease. "Educating caregivers and families about behavioral interventions -- reality and orientation [therapy], reassurance, pet therapy -- is equally important," he said.
The study was funded by the U.S. National Institutes of Health and published in the Feb. 19 issue of the Journal of the American Medical Association.
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