Vol.1, No.2, 13-16 (2012) Advances in Alzheimer ’s Disease
Gabapentin for the treatment of behavioral and
psychological symptoms of dementia*
Rajesh R. Tampi1#, Banu Ozkan2, Deena Williamson3
1Department of Psychiatry, Yale University School of Medicine, New Haven, USA;
*Corresponding Author: rajesh.tampi@yale.edu
2Department of Psychiatry, University of Maryland, Baltimore, USA
3Saint Francis Hospital and Medical Center, Hartford, USA
Received 13 July 2012; revised 18 August 2012; accepted 26 August 2012
Objective: To examine th e efficacy of gabapentin
for the treatment of behavioral and psychologi-
cal symptoms of dementia (BPSD). Design: A
retrospective chart review. Settings: Tertiary care
geriatric psychiatry inpatient unit. Participants:
230 patients with BPSD. Measurements: The
socio-demographic information, type of behav-
iors, co-morbid psychiatric and medical diag-
noses, daily doses of medications and side-ef-
fects were recorded. Results: Of the 230 patients,
22 were treated with gabapentin. Twenty of these
patients were on a combination of gabapentin
and an antipsychotic medication while two pa-
tients were treated with gabapentin monother-
apy. Eighteen of the 20 patients in the combina-
tion group tolerated the treatments with little or
no side effects as did the two patients in the
monotherapy group. Conclusions: Gabapentin
may be a safe option for the treatment of BPSD
in combination with antipsychotic medications.
Gabapentin may also be effective as monother-
apy in certain patients with BPSD.
Keywords: Behavioral and Psychological
Symptoms of Dementia; Neuropsychiatric
Symptoms of Dementia; Anticonvulsants;
Behavioral and psychological symptoms of dementia
(BPSD) are a heterogeneous group of non-cognitive
symptoms and behaviors that occur in patients with de-
mentia [1]. BPSD does not reflect a specific diagnostic
entity, but describes an important clinical dimension of
dementia which is often the triggering event for its rec-
ognition and referral to the specialist service [2]. The
development of BPSD is associated with greater impair-
ment in activities of daily living, more cognitive decline
and poorer quality of life, institutionalization and is also
a major risk factor for caregiver burden [3]. In this regard,
BPSD are more important than the progressiv e cognitive
deficits of the disease, and for the care of the patients
with AD [3].
Treatments available for BPSD are currently not stan-
dardized and include various non-pharmacological and
pharmacological approaches [3,4] Pharmacotherapy is
usually initiated when symptoms have failed to respond
to non-pharmacological interventions and are not attrib-
utable to an underlying medical condition or medication
effect [3,4]. A variety of medications have been used to
treat BPSD, including typical and atypical antipsychotics,
antidepressants, anticonvulsant mood stabilizers, choli-
nesterase inhibitors, benzodiazepines and other drugs
While the benefits of antipsychotics and anticonvul-
sants like valproic acid and carbamazepine in the treat-
ment of BPSD are not clear, gabapentin, another anti-
convulsant may be a poten tial treatment for the treatment
of these symptoms [3,4]. Gabapentin is structurally re-
lated to GABA and it probably acts by interfering with
the calcium channels to alter transmitter release. It is
commonly used as an adjunctive therapy for partial sei-
zures. Gabapentin is eliminated unchanged renally, and
its clearance is expected to parallel the age-related de-
crease in glomerular filtration rate. The pharmacokinetics
of gabapentin, specifically the lack of both hepatic me-
tabolism and protein binding, makes gabapentin a drug
that is potentially safer than the other anticonvulsant
agents for the elderly population [5].
The efficacy of gabapentin in treating behavioral
symptoms of dementia has been described in several case
reports and open-label trials but its effect as an adjunct to
antipsychotic treatment has not been studied [6,7]. The
*The other authors have no financial disclosures to make and there are
no conflicts of interes t t o report in the conduct of this study.
#Corresponding author.
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R. R. Tampi et al. / Advances in Alzheim er’s Disease 1 (2012) 13-16
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
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
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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R. R. Tampi et al. / Advances in Alzheim er’s Disease 1 (2012) 13-16
Copyright © 2012 SciRes. OPEN A CCESS
Table 2. Diagnosis, comorbidities and psychotropic medications.
Age Diagnosis Comorbid medical illness Comorbid
illness Psychotropic medications (name/daily dosages)
Dement ia; mixe d
type (AD an d
vascular type),
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,
with full
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,
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,
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,
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
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
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
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
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
2400 mgQuetiapine
37.5 mg Valproic acid
100 mg
78 Dementia;
AD type GERD, Parkinson’s disease,
BAD type II,
1800 mgQuetiapine
250 mg
77 Dementia; mixed type
(AD and Vascular),
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.
[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,
[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.
[5] Birnbaum, A.K. (2007) Pharmacokinetics of antiepileptic
drugs in elderly nursing home residents. International
Review of Neurobiology, 81, 211-220.
[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.
[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.
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