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Valproate Therapy for Agitation in Dementia

Open-Label Extension of a Double-Blind Trial

Received January 24, 2003; revised March 14, March 31, 2003; accepted April 8, 2003. From the Department of Psychiatry, Program in Neurobehavioral Therapeutics, University of Rochester Medical Center and Monroe Community Hospital (APP,PNT,LJJ,NK,CH,RE) and the Department of Biostatistics and Computational Biology, University of Rochester Medical Center (CC; Dr. Cox is now at the National Institutes of Health, Department of Health and Human Services, Rockville, MD). Address correspondence to Dr. Porsteinsson, Department of Psychiatry, Program in Neurobehavioral Therapeutics, University of Rochester Medical Center and Monroe Community Hospital, 435 E. Henrietta Road, Rochester, NY 14620. e-mail: anton_porsteinsson{at}urmc.rochester.edu

Objective: The authors describe an open-label extension of a double-blind, randomized, placebo-controlled study of divalproex sodium in 56 nursing home patients with agitation and dementia. Methods: Participants (N=46) were treated for 6 weeks in an open fashion with clinically optimal doses of divalproex sodium (range: 250 mg/day–1,500 mg/day; mean: 851 mg/day). Behavior was assessed with the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression of Change (CGI) by new raters. Safety, tolerability, and laboratory data were obtained regularly. Results: The mean BPRS Agitation Factor decreased by 3.1 points from baseline; 86% of those completing the open phase were rated as improved on the CGI. These changes were mirrored by changes in other behavior rating scales. Sixty percent of subjects had no side effects; 33% had side effects that were rated as mild. There were no clinically significant changes in laboratory values. Conclusion: Ongoing open-label treatment with divalproex was associated with improvement in measures of agitation. Doses, levels, and tolerability were similar to those in the blinded phase of the study. These findings help confirm and extend the results from the placebo-controlled phase of the trial and suggest that divalproex may be beneficial for some patients with this clinical problem.

Key Words: Valproate • Agitation • Dementia

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