my personal edition > geriatrics > news


  E-Mail this DGReview to a colleague

DGReview

Sodium Valproate Appears Effective for Aggressive Behaviour in Demented Patients with Extended Treatment

Twelve weeks of therapy with sodium valproate improved, distorted memory, disorientation and aggressive, non-social, and apathetic behaviours improved in aggressive patients with dementia, Dutch researchers report.

In a previous controlled trial, Dr. Rob C. Sival, Department of Geriatrics, Parnassia Psychomedical Center, the Hague, and colleagues found that that restless, melancholic, and anxious behaviour improved in aggressive demented patients receiving short-term treatment with sodium valproate, but no effect on aggression was found.

To explore whether or not the course of disturbed behaviour changed further during medium-term treatment, the investigators performed a consecutive open-label observational 12-week follow-up study in 39 (24 female) demented patients at a psychogeriatric wards.

All patients received a starting dose of sodium valproate 2 x 6 mL of a 40 mg/mL suspension (daily defined dose of 480 mg) and were followed up 3 times at 4-week intervals. Treatment was managed by each patient's regular physician, and prescriptions were maintained or adjusted according to clinical symptoms. Concomitant medications were allowed during the study period.

Measurements were performed a the end of each interval and included the Social Dysfunction and Aggression Scale-9 (SDAS-9), the Behaviour Observation scales for Intramural Psychogeriatrics (GIP), and the Clinical Global Impression of aggressive behaviour. In addition, patients and nursing staff were interviewed regarding side effects.

The researchers found that overall, mean sodium valproate prescriptions at week 12 (611.0 mg/day ± 136.4) were higher compared to the starting dose. Improvement was also observed in aggressive behaviour as measured by the SDAS-9, and other improvements observed in the previous trial continued. Alternatively, rebellious behaviour as measured by the GIP was found to have increased at week 12.

Drowsiness was the sole side effect observed during treatment. Two patients discontinued treatment during the study due to ineffectiveness, and a total of 7 patients died (5 women) due to reasons that unrelated to sodium valproate treatment.

Citing evidence from another open-label study, Dr. Sival and colleagues suggest that sodium valproate should be prescribed for a month or more to treat aggressive behaviour in demented patients.

"A prolonged randomised trial is needed to provide definite proof, because of the short comings of the follow-up study: open label, small numbers, additional psychotropic prescriptions and the absence of statistical adjustments for multiple comparisons," they concluded.



Int J Geriatr Psychiatry 2004 Apr;19:4:305-12. "Sodium valproate in aggressive behaviour in dementia: a twelve-week open label follow-up study"

E-Mail this DGReview to a colleague

To print, use this version