tients, 16 were Cauca-
sian (M:F, 10:6), 3 were African America (3:0) and 3
Hispanic (2:1) (Table 1).
All patients had a diagnosis of dementia, of these, 12
patients had Alzheimer’s disease, 6 had dementia of
Table 1. Demographic information of the patients.
Sex Male (n = 15) Female (n = 7)
Age (years) 73.78 76.57
Race
African-American 3 0
Hispanic 2 1
Caucasian 10 6
mixed type, 3 had vascular dementia and 1 patient had
Lewy Body Dementia. Of the twenty-two patients, six
had Folstein Mini Mental State Examination (MMSE)
scores available [9]. The average MMSE score for these
patients was 10.87 ± 6.02. Sixteen of the patients were
unable to co-operate with the MMSE because of severe
impairment in cognitive functioning and agitatio n.
Agitation (verbal aggression) was the most common
behavior noted in these patients. Combative behavior
(physical aggression) was seen in 18 of the 22 patients. A
combination of agitation and physical aggression was
seen in 11 of the 22 patients. Paranoid thoughts (5/22,
23%) and inappropriate sexual behaviors (2/22, 9%)
were less commonly noted in these patients. Confusion
as a complaint was noted only in 5 of the 22 patients
(23%).
A combination of gabapentin and an atypical antipsy-
chotic medication was administered to the 20 patients.
Eighteen of them tolerated this combination with no sid e
effects. Two patients developed side-effects. One patient
who was treated with 1800 mg/day of gabapentin and 20
mg/day of olanzapine became lethargic. The dose of
gabapentin was reduced to 400 mg/day with a reduction
in sedation. The other patient was being treated with 300
mg/day of gabapentin and 75 mg/day quetiapine. Be-
cause of sedation, the dose of gabapentin was decreased
to 200 mg/day. None of the patients in the monotherapy
group had any side-effects.
In the combination treatment group, 11 patients were
on quetiapine, 6 were on olanzapine, 2 were on risperi-
done and 1 was on clozapine. Of the 22 patients, 10 were
on Donepezil 5 - 10 mg/day and 1 was on memantine
and 1 was on both donepezil and memantine. One of the
patients was on valproic acid for seizure disorder, and 2
of them were on both valproic acid and gabapentin for
agitation a n d b e havioral probl ems (Table 2).
Behavioral issues in of all the patients resolved with
these treatments. Twenty patients were discharged to
skilled nursing facilities, 1 patient went to an assisted
living facility and 1 patient went home. The average
length of stay for these patients was 23.23 ± 5.66 days.
4. Discussion
Although some psychotropic medications have been
found to be helpful in the treatment of BPSD, none of
them have proven efficacy and benign side-effect pro-
files [3,4]. Elderly patients also have more medical
co-morbidities and are taking multiple medications. This
puts them at higher risk for developing medical compli-
cations and medication side-effects along with drug-drug
interactions. These issues must be considered while giv-
ing a new medication to the older patient [3,4].
In this study, we used a cobination of atypical anti- m
Copyright © 2012 SciRes. OPEN A CCESS
R. R. Tampi et al. / Advances in Alzheim er’s Disease 1 (2012) 13-16
Copyright © 2012 SciRes. OPEN A CCESS
15
Table 2. Diagnosis, comorbidities and psychotropic medications.
Age Diagnosis Comorbid medical illness Comorbid
psychiatric
illness Psychotropic medications (name/daily dosages)
83
Dement ia; mixe d
type (AD an d
vascular type),
moderate
anemia, post CVA, CAD,
chronic orthostatic hypotension,
hypertension, AF, CRI no Gabapentin
400 mg Memantine
20 mg
64 Dementia;
AD type, severe
DM type2, CAD, post MI,
hyperlipidemia, vitamin
B12 deficiency,
alchohol
dependence
with full
remission
Gabapentin
800 mg Donepezil
10 mg Olanzapine
15 mg
73 Dementia;
AD type vitamin B12 deficiency MDD with
anxiety Gabapentin
600 mg Donepezil
5 mg Quetiapine
400 mg
76 Dementia;
AD type,
moderate
hypertension, DM type II,
CRI, BPH, gout no Gabapentin
800 mg Olanzapine
15 mg
67 Dementia;
AD type hypertension, urinar y
incontinence, BPH no Gabapentin
500 mg Olanzapine
15 mg Donepezil
5 mg Memantine
15 mg
85 Dementia;
AD type, severe
CRI, osteoarthritis, recurrent
UTI, dejenarative joint disease,
hypertension, stress urinary
incontinence, chronic leg edema
no Gabapentin
300 mg Olanzapine
7.5 mg
64 Dementia;
AD type, severe
DM type II, seizure disorder ,
tinea corporis of the right buttock,
anemia of chronic disease no Gabapentin
1200 mgValproic acid
1250 mg
83 Dementia;
vascular type,
moderate
hypertension, CAD, CHF,
anemia, NIDDM, hyperlipidemia no Gabapentin
100 mg Quetiapine
150 mg Donepezil
10 mg Citalopram
30 mg
90 Dementia;
vascular type hypertension, glaucoma,
post left CVA, post cyst removal in her br e astno Gabapentin
200 mg Quetiapine
100 mg Donepezil
10 mg
64 Dementia;
vascular type,
moderate
hypertension, CAD, DM , post
bilateral above knee amputation,
MRSA and vancomicyn
resistant enterococci wound
infection left thigh
no Gabapentin
400 mg Risperidole
2.5 mg Donepezil
5 mg Valproic acid
1000 mg
68 Dement ia; mixe d
type (AD and
alcohol induced), severe BPH, hypercholesterolemia History of
alcohol
dependence
Gabapentin
1200 mgOlanzapine
10 mg Donepezil
10 mg
78 Dementia;
AD type, severe hypertension, hyper t hyroidism,
NIDDM no Gabapentin
900 mg Quetiapine
25 mg prn Donepezil
10 mg
79 Dement ia; mixe d
type, severe chronic pain, CVA, post UTI,
fungal groin infection no Gabapentin
600 mg Memantine
5 mg
67 Dementia; AD
type, severe
hypertension, bronchitis, GERD,
hypocholesterolemi a, Raynaud’s
disease, post lung ca, post left
lung-upper lobe lobectomy
no Gabapentin
400 mg Clozapine
200 mg Valproic acid
500 mg
82 Dementia; AD
type, severe arthritis no
Gabapentine
200 mg Quetiapine
75 mg
81 Dementia; AD
type, severe hypertension, BPH, history
of diverticulosis no Gabapentin
600 mg Quetiapine
200 mg Donepezil
10 mg
84 Dementia; mixed type
(AD and
Vascular)
delirium due to multiple medical
causes, NIDDM, rapid AF,
hypothyroidism, chronic anemia,
post epidural hematoma ,
post left breast mastectomy
no Gabapentin
1200 mgQuetiapine
200 mg Donepezil
5 mg
R. R. Tampi et al. / Advances in Alzheim er’s Disease 1 (2012) 13-16
16
Continued
67 Dementia; Lewy
body type
hyperkalemia, MRSA-positive,
coccygeal decubitus, resolving,
dysphagia secondary to deme ntia no Gabapentin
3000 mgOlanzapine
20 mg Donepezil
10 mg
83 Demen tia; mixed
type (AD
and Vascular)
recurrent UTI, CVA with
hemiplegia and aphasia, AF,
cardiomegaly, degenarative
joint disease
no Gabapentin
2000 mgRisperidole
2.5 mg
59 Dementia; AD
type, severe hypertension no
Gabapentin
2400 mgQuetiapine
37.5 mg Valproic acid
100 mg
78 Dementia;
AD type GERD, Parkinson’s disease,
hypertension
BAD type II,
hypomanic
episode
Gabapentin
1800 mgQuetiapine
250 mg
77 Dementia; mixed type
(AD and Vascular),
severe
IDDM, hypertension, GERD,
phimosis & balanitis with penile
discharge positive for MRSA no Gabapentin
200 mg Quetiapine
400 mg
AD = Alzheimer’s Disease; CVA = Cerebral Vascular Accident; CAD = Coronary Artery Disease; CRI = Chronic Renal Failure; MI = Myo-
cardial Infarctus; BPH = Benign Prostate Hypertrophy; UTI = Urinary Tract Infection; CHF = Chronic Heart Failure; NIDDM = Non-Insulin
Dependent Diabetes Mellitus; MRSA= Methicillin Resistant Staphylococcus aereus; GERD = Gastroesophageal R e f l ux D i se a s e ; A F = Atrial
Fibrillation; MDD = Major Depressive Disorder; BAD = Bipolar Affective Disorder.
psychotic medication and gabapentin, which appears to
be effective and well tolerated in the treatment of BPSD.
Gabapentin was also effective as monotherapy for the
treatment of two cases of BPSD. Side-effect profile was
relatively benign and no drug-drug interactions were
noted. Our finding is in keeping with the case-series by
Moretti et al. [6], Herrmann et al. [7], where they found
that gabapentin monotherapy was well tolerated and ef-
fective for the treatment of BPSD. However, our study
also indicated that gabapentin was well tolerated even in
combination with atypical antipsychotics.
As this study is a retrospective chart review and has
potential for bias, further controlled studies are necessary
to confirm the efficacy of the combination treatments for
BPSD. However, this current study provides the proof
that elderly patients with BPSD tolerate a combinatio n o f
psychotropic medications, if these medications are dosed
appropriately and monitored carefully.
5. Conclusion
Behavioral and psychological symptoms are common
in dementia. The treatment for these important symptoms
is not standardized and is limited by the side-effect pro-
file of the various drugs. Gabapentin, an anticonvulsant
medication may be beneficial in combination with an-
tipsychotic agents or as monotherapy for patients pre-
senting with these behaviors.
REFERENCES
[1] Barucha, A.J., Rosen, J., Mulsant, B.H. and Pollock, B.G.
(2002) Assessment of behavioral and psychological
symptoms of deme ntia. CNS Spectrums, 7, 797-802.
[2] Lawlor, B. (2002) Managing behavioural and psycho-
logical symptoms in dementia. British Journal of Psy-
chiatry, 12, 463-465. doi:10.1192/bjp.181.6.463
[3] Tampi, R.R. and Van Dyck, C.H. (2006) Behavioral and
psychological symptoms of Alzheimer’s disease. In:
Miao-Kun, S., Ed., Research Progress in Alzheimers Dis-
ease, Nova Science Publishers, Hauppauge, New York,
245-258.
[4] Sink, K.M., Holden, K.F. and Yaffe, K. (2005) Pharma-
cological treatment of neuropsychiatric symptoms of de-
mentia: A review of the evidence. Journal of American
Medical Associati on, 293, 596-608.
doi:10.1001/jama.293.5.596
[5] Birnbaum, A.K. (2007) Pharmacokinetics of antiepileptic
drugs in elderly nursing home residents. International
Review of Neurobiology, 81, 211-220.
doi:10.1016/S0074-7742(06)81013-5
[6] Moretti, R., Torre, P. and Rodolfo, M.A., et al. (2003)
Gabapentin for the treatment of behavioural alterations in
dementia. Drugs Aging, 20, 1035-1040.
[7] Herrmann, N., Lanctot, K. and Myszak, M. (2000) Effec-
tiveness of gabapentin for the treatment of behavioral
disorders in dementia. Journal of Clinical Psychophar-
macology, 20, 90-93.
doi:10.1097/00004714-200002000-00015
[8] Quick Reference to the Diagnostic Criteria from
DSM-IV-TR™ (2000) American Psychiatric Association,
Washington DC, 88-95.
[9] Folstein, M., Folstein, S. and McHugh, P. (1975) Mini-
mental state: A practical method for grading the cognitive
state of patients for the clinician. Journal of Psychiatric
Research, 12, 189-198.
doi:10.1016/0022-3956(75)90026-6
Copyright © 2012 SciRes. OPEN A CCESS