Anticonvulsants in the treatment of aggression in the demented elderly: an update.
BACKGROUND
Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity.


METHODS
Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate.


RESULTS
To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate.


CONCLUSIONS
So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.
Amann
Benedikt
B
Benito Menni, CASM, Research Unit, CIBERSAM, St Boi de Llobregat, Barcelona, Spain. benedikt.amann@med.uni-muenchen.de.
Pantel
Johannes
J
Grunze
Heinz
H
Vieta
Eduard
E
Colom
Francesc
F
Gonzalez-Pinto
Ana
A
Naber
Dieter
D
Hampel
Harald
H