Drug May Calm Agitation From Alzheimer's
Antipsychotic Drug Shows Promise in Agitated Alzheimer's Patients
July 22, 2004 (Philadelphia) -- Caregivers of Alzheimer's patients know all too well the behavioral problems, such as agitation, that often accompany the memory loss seen in Alzheimer's disease. But researchers have now found that a medication may help tame agitation.
Agitation associated with Alzheimer's disease is the No. 1 reason that dementia patients are admitted to nursing homes, says Pierre Tariot, MD, a professor of psychiatry, neurology, and aging at the University of Rochester. Agitated Alzheimer's patients pose a threat to themselves and to caregivers, he says.
He says doctors have been using antipsychotic drugs like Zyprexa, Risperdal, and Seroquel to calm agitated Alzheimer's patients for some time, but the drugs have been used with no evidence to back up safety or efficacy. Moreover, the FDA has not approved any drug for treatment of agitation associated with dementia.
Tariot's study looked at whether these drugs worked to calm agitation in elderly patients with dementia living in a nursing home. The 10 week study compared two doses of Seroquel -- 100 mg/day and 200 mg/day -- to placebo. The study was funded by and Tariot received research support from AstraZeneca, Seroquel's manufacturer.
After 10 weeks of treatment, 117 patients taking 200 mg/day had significant improvement in agitation, and 60% of those patients were rated as "much improved" by their doctors. The change in behavior of patients treated with the higher dose was significantly better than those treated with either a low dose of the drug or placebo, he says.
The study was presented at the 9th International Conference on Alzheimer's Disease and Related Disorders.
But even with the positive results of the study, Tariot tells WebMD that a drug should never be the first choice when treating agitation in patients with dementia.
He says the first line of treatment should be a careful evaluation of the patient beginning with a urine test because "urinary tract infections are the No. 1 cause of agitation in Alzheimer's disease patients."
If there is no evidence of a urinary tract infection, Tariot says it is important to check the patient's environment because things like moving a patient from one room to another or exposing the patient to a new or unusual noise -- construction sounds outside or a new noisy roommate -- can trigger agitation. Likewise, the agitation may signal some need that the patient has not been able to communicate to caregivers.
While such assessments take time, Tariot says they are the key to optimal patient care.
He says agitation is more likely to occur among patients in late-stage disease and notes that once agitation occurs, it is likely to persist throughout the course of the disease.
William Thies, PhD, vice president of medical and scientific affairs for the Alzheimer's Association, tells WebMD that agitation is a major treatment problem in Alzheimer's disease, yet "we haven't had any evidence about efficacy or safety. This study is a major finding, and I think it is one of the most significant studies presented at this meeting."
Thies says it is especially significant that the study showed that the medication does not appear to increase the risk of any side effects.
Tariot has received research support including honoraria and consultant fees from AstraZeneca as well as from Abbott, Bristol-Myers Squibb, Eisai, Forest, Janssen, Novartis, and Pfizer pharmaceuticals.