title: Valproate therapy for agitation in dementia: open-label extension of a double-blind trial.
abstract: OBJECTIVE
  The authors describe an open-label extension of a double-blind, randomized, placebo-controlled study of divalproex sodium in 56 nursing home patients with agitation and dementia.
  
  
  METHODS
  Participants (N=46) were treated for 6 weeks in an open fashion with clinically optimal doses of divalproex sodium (range: 250 mg/day-1,500 mg/day; mean: 851 mg/day). Behavior was assessed with the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Change (CGI) by new raters. Safety, tolerability, and laboratory data were obtained regularly.
  
  
  RESULTS
  The mean BPRS Agitation Factor decreased by 3.1 points from baseline; 86% of those completing the open phase were rated as improved on the CGI. These changes were mirrored by changes in other behavior rating scales. Sixty percent of subjects had no side effects; 33% had side effects that were rated as mild. There were no clinically significant changes in laboratory values.
  
  
  CONCLUSIONS
  Ongoing open-label treatment with divalproex was associated with improvement in measures of agitation. Doses, levels, and tolerability were similar to those in the blinded phase of the study. These findings help confirm and extend the results from the placebo-controlled phase of the trial and suggest that divalproex may be beneficial for some patients with this clinical problem.
authors.affiliation: Department of Psychiatry, Program in Neurobehavioral Therapeutics, University of Rochester Medical Center and Monroe Community Hospital, tochester, NY 14620, USA. anton_porsteinsson@urmc.rochester.edu
authors.forename: Anton P
authors.initials: AP
authors.lastname: Porsteinsson
authors.forename: Pierre N
authors.initials: PN
authors.lastname: Tariot
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Jakimovich
authors.forename: Nancy
authors.initials: N
authors.lastname: Kowalski
authors.forename: Connie
authors.initials: C
authors.lastname: Holt
authors.forename: Rosemary
authors.initials: R
authors.lastname: Erb
authors.forename: Christopher
authors.initials: C
authors.lastname: Cox
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology*; D010054:Brief Psychiatric Rating Scale; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D004791:Enzyme Inhibitors; D014635:Valproic Acid