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 DLB patients w/behavioral problems did not tolerate 2 meds 
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post DLB patients w/behavioral problems did not tolerate 2 meds
One result of this study is not surprising -- that most DLB patients with behavioral disturbances or psychosis did not tolerate Risperdal (an antipsychotic). This antipsychotic is notorious for motor and psychiatric side effects in most DLB patients. (Many neurologists I know do not prescribe this medication unless the usual stand-bys of Seroquel and Clozaril don't work.) I find it odd that the researchers chose Risperdal because "existing literature that supported the use of these agents, specifically, in the treatment of dementia with behavioral disturbances when this study started."

What was surprising was that most DLB patients did not tolerate Celexa (an SSRI anti-depressant). (This is the first randomized controlled trial of an antidepressant in DLB.) And it's a little surprising that those with AD given the same medications improved.

Why study participants stopped taking the study medication is interesting. "A high proportion of the dropouts were owing to worsening of psychiatric symptoms. ... In contrast to earlier reports, neurologic adverse events were infrequent overall. This finding may in part be explained by the very careful and controlled dose titration schedules that were followed in our study." We'd have to read the study to know what a "neurologic adverse event" is and how that's different from a psychiatric adverse event.

One weakness of this study is that there's no pathological confirmation of the DLB or AD diagnoses. The diagnostic accuracy of DLB is less than 33%.

I've copied the abstract below.

Robin



Alzheimer's Disease & Associated Disorders. 2010 Jul 9. [Epub ahead of print]

Treating Neuropsychiatric Symptoms in Dementia With Lewy Bodies: A Randomized Controlled-trial.

Culo S, Mulsant BH, Rosen J, Mazumdar S, Blakesley RE, Houck PR, Pollock BG.
Department of Psychiatry, University of British Columbia, Vancouver; Department of Psychiatry, Centre for Addiction and Mental Health, and University of Toronto; Rotman Institute, Baycrest, Toronto, Canada; Departments of Psychiatry, Western Psychiatric Institute and Clinic section; Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh.

Trial Registration Clinical Trials.gov Identifier: NCT00073658.

Abstract
Sensitivity to psychotropic medications presents a therapeutic challenge when treating neuropsychiatric symptoms in patients with dementia with Lewy bodies (DLB).

We compared under randomized, double-blinded conditions the tolerability and efficacy of citalopram and risperidone in the treatment of behavioral and psychotic symptoms in patients with DLB and Alzheimer disease (AD).

Thirty-one participants with DLB and 66 with AD hospitalized for behavioral disturbance were treated under randomized, double-blind conditions with citalopram or risperidone for up to 12 weeks. Neuropsychiatric symptoms were assessed with the nursing home version of the Neuropsychiatric Inventory (NPI) and the Clinical Global Impression of Change (CGIC). Side effects were measured using the UKU Side Effect Rating Scale.

A significantly higher proportion of participants with DLB (68%) than with AD (50%) discontinued the study prematurely. Discontinuation rates were comparable in DLB participants treated with citalopram (71%) or risperidone (65%). However, participants with DLB randomized to risperidone experienced a higher overall burden of side effects.

Scores on the NPI and the CGIC worsened in DLB participants and improved in those with AD.

Most patients with behavioral disturbances or psychosis associated with DLB tolerate citalopram or risperidone poorly and do not seem to benefit from either medication.

PubMed ID#: 20625270 (see pubmed.gov for this abstract only)

[Note: risperidone = Risperdal; citalopram = Celexa]


Mon Jul 19, 2010 2:46 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Post Re: DLB patients w/behavioral problems did not tolerate 2 me
Is this why SNRIs, rather than SSRIs are being prescribed for LBD now?

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Jul 19, 2010 7:20 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: DLB patients w/behavioral problems did not tolerate 2 me
I don't think these two concepts are related because I don't think there's broad consensus about DLB treatment within the general neurologist community.


Mon Jul 19, 2010 9:07 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: DLB patients w/behavioral problems did not tolerate 2 me
Unfortunately, Robin, I'm afraid you're right.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Jul 19, 2010 10:06 pm
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