Treatment of Aggressive Behavior in Dementia With the Anticonvulsant Topiramate: A Retrospective Pilot Study
|Benny Fhager a1, Inga-Maj Meiri a1, Magnus Sjögren a1 and Åke Edman a1|
a1 Göteborg University, Institute of Clinical Neuroscience, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden
Aggressive behavior in dementia often has a severe impact on the quality of life of the patient and the caregivers, and is therefore important to handle. The strategy of treatment should be broad. Nonpharmacological interventions, including environmental adjustments and supporting and training the caregivers, should always be considered. Pharmacological treatment of aggressive behavior in patients with dementia often includes the use of neuroleptics. The atypical compounds clozapine, risperidone, and olanzapine have been shown to have an effect on aggressive behavior at low dosage with limited extrapyramidal side effects. The anticonvulsants carbamazepine and sodium valproate are further alternatives. In treatment-resistant cases, buspirone or lithium may be tried, although the effect of these substances on aggressive behavior in dementia has not been well established. In the end, however, a considerable degree of aggressive behavior sometimes remains after careful treatment trials, particularly in patients with severe aggressive behavior. In addition, treatment is sometimes limited by side effects.
Key Words: Aggression; BPSD; dementia; anticonvulsant; topiramate.