While antipsychotics have been used to treat psychosis or aggressive behaviors in dementia populations, they appear to have a high side effect profile that leads to high discontinuation rates.1 Additionally, antipsychotics, as a class, carry a black box warning for use in the dementia population. Both CMS and APA have announced initiatives over the past two years to reduce the inappropriate prescribing of antipsychotics in order to manage BPSD. Mood stabilizers may be considered as an alternative to neuroleptics. This table presents data on the efficacy of mood stabilizing drugs for the management of BPSD.

Table 1.

Management of behavioral and psychological symptoms of dementia

Management of behavioral and psychological symptoms of dementia
Management of behavioral and psychological symptoms of dementia
1.
Schneider
LS
,
Tariot
PN
,
Dagerman
KS
,
Davis
SM
,
Hsiao
JK
,
Ismail
MS
et al
.
Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease
.
N Engl J Med
.
2006
;
355
(
15
):
1525
38
.
DOI: 10.1056/NEJMoa061240. PubMed PMID: 17035647
.
2.
Tariot
PN
,
Erb
R
,
Podgorski
CA
,
Cox
C
,
Patel
S
,
Jakimovich
L
et al
.
Efficacy and tolerability of carbamazepine for agitation and aggression in dementia
.
Am J Psychiatry
.
1998
;
155
(
1
):
54
61
.
PubMed PMID: 9433339
.
3.
Olin
JT
,
Fox
LS
,
Pawluczyk
S
,
Taggart
NA
,
Schneider
LS.
A pilot randomized trial of carbamazepine for behavioral symptoms in treatment-resistant outpatients with Alzheimer disease
.
Am J Geriatr Psychiatry
.
2001
;
9
(
4
):
400
5
.
PubMed PMID: 11739066
.
4.
Herrmann
N
,
Lanctôt
KL
,
Rothenburg
LS
,
Eryavec
G.
A placebo-controlled trial of valproate for agitation and aggression in Alzheimer's disease
.
Dement Geriatr Cogn Disord
.
2007
;
23
(
2
):
116
9
.
DOI: 10.1159/000097757. PubMed PMID: 17148938
.
5.
Tariot
PN
,
Schneider
LS
,
Cummings
J
,
Thomas
RG
,
Raman
R
,
Jakimovich
LJ
et al
.
Chronic divalproex sodium to attenuate agitation and clinical progression of Alzheimer disease
.
Arch Gen Psychiatry
.
2011
;
68
(
8
):
853
61
. .
6.
Mowla
A
,
Pani
A.
Comparison of topiramate and risperidone for the treatment of behavioral disturbances of patients with Alzheimer disease: a double-blind, randomized clinical trial
.
Journal of Clinical Psychopharmacology
.
2010
;
30
(
1
):
40
3
. .
7.
Sommer
OH
,
Aga
O
,
Cvancarova
M
,
Olsen
IC
,
Selbaek
G
,
Engedal
K.
Effect of oxcarbazepine in the treatment of agitation and aggression in severe dementia
.
Dement Geriatr Cogn Disord
.
2009
;
27
(
2
):
155
63
.
DOI: 10.1159/000199236. PubMed PMID: 19182483
.
8.
Cooney
C
,
Murphy
S
,
Tessema
H
,
Freyne
A.
Use of Low-Dose Gabapentin for Aggressive Behavior in Vascular and Mixed Vascular/Alzheimer Dementia
.
J Neuropsychiatry Clin Neurosci
.
2013
;
25
(
2
):
120
. .
9.
DEVARAJAN
S.
Aggression in Dementia With Lamotrigine Treatment
.
American Journal of Psychiatry
.
2000
;
157
(
7
):
1178
1178
. .
10.
Ng
B
,
Camacho
A
,
Bardwell
W
,
Sewell
DD.
Lamotrigine for agitation in older patients with dementia
.
Int Psychogeriatr
2009
;
21
:
207
8
.
11.
WEINER
MYRONF
,
WOMACK
KYLEB
,
MARTIN-COOK
KRISTIN
,
SVETLIK
DORISA
,
HYNAN
LINDAS.
Levetiracetam for agitated Alzheimer's disease patients
.
Int. Psychogeriatr
.
2005
;
17
(
2
):
327
328
. .
12.
Kyomen
HH
,
Whitfield
TH
,
Baldessarini
RJ.
Levetiracetam for manic behavior in hospitalized geriatric patients with dementia of the Alzheimer's type
.
Journal of Clinical Psychopharmacology
.
2007
;
27
(
4
):
408
10
. .