title: Olanzapine as a possible treatment for anxiety due to vascular dementia: an open study.
abstract: Disabilities caused by behavioral problems can be potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety, and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they can be accompanied by significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism, and akathisias. Agitation is a major problem in older patients with dementia. Agitation and aggression have always been difficult behaviors to manage, and when it is severe, agitation can be a behavioral emergency that requires urgent and immediate intervention. This six-month study included a group of 94 outpatients (48 men and 46 women) who had a diagnosis of subcortical vascular dementia (VaD). To be eligible for the study, patients needed a score of at least 3 for agitation/aggression on the Neuropsychiatric Inventory (NPI), suggesting at least moderate frequency and/or severity, and 0 for delusions and hallucinations. Patients were divided into two homogenous groups. Group A received olanzapine (2.5-5 mg/day) and Group B received bromazepam (0.25 percent, 15 drops, three times per day). Patients in both groups were allowed to continue any previous therapy. Patients receiving olanzapine at an average dose of 3.21 +/- 1.02 mg/day showed statistically significant improvement on the anxiety rating compared with those receiving bromazepam. Our patients had a host of medical conditions and received numerous concomitant medications. Given the potential complications associated with these therapeutic agents, these patients tolerated olanzapine quite well. It appeared that adverse events, particularly somnolence, postural instability, and postural hypotension, were mild and transient. Moreover, no anticholinerigic effect was registered. These findings suggest that olanzapine could be a safe and effective treatment for anxiety in cognitively impaired patients.
authors.affiliation: Dipartimento di Fisiologia e Patologia, Dipartimento di Medicina Clinica e Neurologia, UCO di Neurologia, Sezione Disturbi Cognitivi, Università di Trieste, Trieste, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Moretti
authors.forename: Paola
authors.initials: P
authors.lastname: Torre
authors.forename: Rodolfo M
authors.initials: RM
authors.lastname: Antonello
authors.forename: Tatiana
authors.initials: T
authors.lastname: Cattaruzza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cazzato
authors.forename: Antonio
authors.initials: A
authors.lastname: Bava
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000188:drug therapy* / Q000209:etiology*; D001569:Benzodiazepines / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology; D015140:Dementia, Vascular / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D000077152:Olanzapine; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D001569:Benzodiazepines; D000077152:Olanzapine; D017367:Selective Serotonin Reuptake Inhibitors