Comparison of topiramate and risperidone for the treatment of behavioral disturbances of patients with Alzheimer disease: a double-blind, randomized clinical trial.
BACKGROUND
Behavioral disturbances are determining factors in handling patients with Alzheimer dementia. The current pharmacotherapy for behavioral symptoms associated with dementia is not satisfactory. Our goal was to compare a new anticonvulsant, topiramate, with a usually used medication, risperidone, for controlling behavioral disturbances of patients with Alzheimer dementia.


METHODS
Elderly patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of Alzheimer disease and significant behavioral disturbances were randomized to receive, for a period of 8 weeks, a flexible dose of either topiramate (25-50 mg/d) or risperidone (0.5-2 mg/d). Outcome measures were the Cohen-Mansfield Agitation Inventory, Neuropsychiatry Inventory parts 1 and 2, and the Clinical Global Impression.


RESULTS
Forty-eight patients were randomized to treatment with either topiramate or risperidone, and 41 patients (21 of 25 in topiramate group and 20 of 23 in risperidone group) completed the trial. Both groups showed significant improvement in all outcome measures without important difference (Neuropsychiatry Inventory total score P < 0.531, Z = 0.62; Cohen-Mansfield Agitation Inventory P < 0.927, Z = 0.09; Clinical Global Impression, P < 0.654, Z = 0.48). There were no significant changes in the cognitive status of patients (assessed by Mini-Mental Status Examination) taking topiramate or risperidone during the trial.


CONCLUSIONS
Treatment with a low dose of topiramate (25-50 mg/d) demonstrated a comparable efficacy with risperidone in controlling behavioral disturbances of patients with Alzheimer dementia.
Mowla
Arash
A
Department of Psychiatry, Persian Gulf Bioscience Research Center, Bushehr University of Medical Sciences, Bushehr, Iran. mowlaar@gmail.com
Pani
Azadeh
A
D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology*; D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001526:Behavioral Symptoms / Q000188:drug therapy*; D017028:Caregivers / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005632:Fructose / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000523:psychology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000523:psychology; D018967:Risperidone / Q000494:pharmacology / Q000627:therapeutic use*; D000077236:Topiramate; D016896:Treatment Outcome
D000927:Anticonvulsants; D014150:Antipsychotic Agents; D000077236:Topiramate; D005632:Fructose; D018967:Risperidone