Sodium valproate in aggressive behaviour in dementia: a twelve-week open label follow-up study.
BACKGROUND
Short-term randomised clinical trials on valproate in distinct types of disturbed behaviour in dementia showed no effects on aggressive behaviour.


OBJECTIVE
To assess the course of disturbed behaviour during medium term treatment with sodium valproate for aggressive behaviour.


METHODS
An open label observational 12-week follow-up study consecutive to a preceding randomised control trial; assessments at 4-week interval.


METHODS
A psychogeriatric medium-stay ward at a psychiatric teaching hospital and psychogeriatric nursing home wards.


METHODS
Patients who completed a preceding randomised placebo controlled clinical trial on sodium valproate in aggressive behaviour in dementia were included.


METHODS
The starting dose of sodium valproate was 2 x 6 ml of a 40 mg/ml suspension (daily defined dose of 480 mg). The patient's regular physicians managed all treatment decisions, including decisions on dosage and plasma level measurements of sodium valproate and decisions regarding discontinuation. Co-medication was allowed and any change in prescription was recorded.


METHODS
The Social Dysfunction and Aggression Scale-9 (SDAS-9), the Behaviour Observation scales for Intramural Psychogeriatrics (in Dutch: Gedragsobservatieschaal voor Intramurale Psychogeriatrie (GIP) and the Clinical Global Impression of aggressive behaviour (CGI) were performed at the last week of each 4-week interval.


RESULTS
Data of 39 patients (F=24 and M=15) were analysed. At week 12 compared to week 0 mean sodium valproate prescriptions were higher; aggressive behaviour as measured by the SDAS-9 improved. Non-social behaviour, apathetic behaviour, disoriented behaviour and distorted memory improved, but rebellious behaviour increased as measured by the GIP. Seven patients died during this study.


CONCLUSIONS
Open label observational design; absence of placebo/reference prescription; no systematic measurements of sodium valproate plasma levels and the allowance of psychotropic co-medication.


CONCLUSIONS
Low dose sodium valproate may be effective reducing a broad range of types of disturbed behaviours in aggressive demented patients. The high death rate underlines the fragility of demented patients with aggressive behaviour.
Sival
Rob C
RC
Department of Geriatrics, Parnassia Psychomedical Center, The Hague, The Netherlands. r.sival@parnassia.nl
Duivenvoorden
Hugo J
HJ
Jansen
Paul A F
PA
Haffmans
P M Judith
PM
Duursma
Sijmen A
SA
Eikelenboom
Piet
P
D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000187:drug effects*; D000704:Analysis of Variance; D018692:Antimanic Agents / Q000627:therapeutic use*; D003704:Dementia / Q000523:psychology*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012920:Social Behavior Disorders / Q000188:drug therapy* / Q000209:etiology; D014635:Valproic Acid / Q000627:therapeutic use*
D018692:Antimanic Agents; D014635:Valproic Acid