title: Effects of Citalopram on Neuropsychiatric Symptoms in Alzheimer's Dementia: Evidence From the CitAD Study.
abstract: OBJECTIVE
  Citalopram has been shown to improve agitation in patients with Alzheimer's disease. The authors evaluated whether other neuropsychiatric symptoms improve with citalopram treatment compared with placebo.
  
  
  METHODS
  In this planned secondary analysis of the Citalopram for Agitation in Alzheimer's Disease study, the authors evaluated the effect of citalopram on the 12 neuropsychiatric symptom domains assessed by the Neuropsychiatric Inventory (NPI). They compared caregiver-reported NPI scores at week 9 in patients receiving citalopram (30 mg/day) or placebo with regard to both the presence or absence of individual neuropsychiatric symptoms and individual domain scores (reflecting severity) in participants who had symptoms at week 9.
  
  
  RESULTS
  At week 9, participants treated with citalopram were significantly less likely to be reported as showing delusions (odds ratio=0.40), anxiety (odds ratio=0.43), and irritability/lability (odds ratio=0.38). A comparison of median scores of participants with symptoms present at week 9 showed significant differences favoring citalopram for hallucinations and favoring placebo for sleep/nighttime behavior disorders.
  
  
  CONCLUSIONS
  While dosage constraints must be considered because of citalopram's adverse effect profile, this agent's overall therapeutic effects in patients with Alzheimer's disease and agitation, in addition to efficacy for agitation/aggression, included reductions in the frequency of irritability, anxiety, and delusions; among patients who had these symptoms at week 9, they included a reduction in the severity of hallucinations but an increase in the severity of sleep/nighttime behavior disorders.
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Leonpacher
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Peters
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Lea T
authors.initials: LT
authors.lastname: Drye
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Makino
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Newell
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Constantine
authors.initials: C
authors.lastname: Frangakis
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Munro
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Jacobo E
authors.initials: JE
authors.lastname: Mintzer
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Pollock
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Rosenberg
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Lon S
authors.initials: LS
authors.lastname: Schneider
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: David M
authors.initials: DM
authors.lastname: Shade
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weintraub
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Jerome
authors.initials: J
authors.lastname: Yesavage
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
authors.affiliation: From the Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore; the Johns Hopkins Bloomberg School of Public Health, Baltimore; the Alzheimer's Disease Care, Research, and Education Program, University of Rochester School of Medicine and Dentistry, Rochester, N.Y.; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford; the Division of Geriatric Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York; the Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, and the Department of Psychiatry, Ralph H. Johnson VA Medical Center, Charleston, S.C.; the Campbell Institute, Centre for Addiction and Mental Health, and the Department of Psychiatry, University of Toronto, Toronto; the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Keck School of Medicine of University of Southern California, Los Angeles; and the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Anton P
authors.initials: AP
authors.lastname: Porsteinsson
mesh_terms: D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use; D001007:Anxiety / Q000150:complications / Q000188:drug therapy*; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003702:Delusions / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006212:Hallucinations / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007508:Irritable Mood / Q000187:drug effects*; D008297:Male; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000150:complications
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram