R. R. Tampi et al. / Advances in Alzheim er’s Disease 1 (2012) 13-16
14
purpose of this report is to consider the efficacy of
gabapentin as an adjunctive therapy to antipsychotics and
also as monotherapy for behavioral and psychological
sy mptoms of dementia.
2. Methods
The data for this case series is derived from a retro-
spective chart review of 230 demented inpatients, dis-
charged between July 1st, 2002 and March 31st, 2007
from the Geriatric Psychiatry Unit of a University Hos-
pital. All these patients were diagnosed with dementia
according to the Diagnostic and Statistical Manual of
Mental Disorders, Text Revision, 4th edition (DSM-
IV-TR) [8].
Medications given to treat these patients were evalu-
ated and the charts of all patients who had BPSD and
were treated with gabapentin were selected for this re-
view. Patients were treated with gabapentin if they could
not tolerate higher doses of the antipsychotic agents and
need further stabilization of their behavioral problems.
The socio-demographic information, co-morbid psychi-
atric and medical diagnoses, daily doses of gabapentin
and antipsychotics, effects and side-effects of gabapentin
were recorded.
As this was a retrospective chart review, a waiver of
consent was obtained from the University Institutional
Review Board for the conduct of this study.
3. Results
The total number of patients with dementia who were
treated with gabapentin was twenty-two. Twenty of these
patients were on a combination of atypical antipsychotic
medication and gabapentin while two patients were
treated with gabapentin monot herapy.
The average age of the patients in the study was 73 ±
8.69 years. There were 15 male patients with an average
age of 73.78 years and 7 female patients with an average
age of 76.57 years. Of these 22 patients, 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
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