Meinhold Jane M, Blake Lesley M, Mini Louis J, Welge Jeffrey A, Schwiers Michael, Hughes Anthony
Department of Neuroscience, Abbott Laboratories, Abbott Park, Illinois 60064, USA.
Drugs Aging. 2005;22(7):615-26. doi: 10.2165/00002512-200522070-00007.
Behavioural and psychological symptoms of dementia (BPSD) occur in up to 90% of individuals with dementia at some point in their illness. BPSD reduce patient quality of life, cause great distress to caregivers and are the most common reason for institutionalisation. In nursing homes, pharmacological measures (usually antipsychotics or benzodiazepines) are often required to control agitation and aggression in patients with dementia. However, no medications have been approved by the US Food and Drug Administration for this indication as yet. The antiepileptic agent divalproex sodium may have advantages in this setting because of lower rates of drug interactions and adverse effects in this patient population.
The aim of the study was to assess the impact of treatment with divalproex sodium on behavioural, mood and cognitive measures in a population of elderly nursing home residents with a history of behaviour problems associated with dementia.
The study was a retrospective analysis of a long-term care database which allowed assessment of the impact of divalproex sodium therapy on behavioural, mood and cognitive measures in elderly nursing home residents with a history of dementia-related behaviour problems. Minimum Data Set items relating to problems of behaviour, cognition and mood were collected prior to and after divalproex sodium treatment over a 1-year period. Two-phase generalised linear regression, with fixed intersections at the time of divalproex sodium initiation, was used to estimate trends in each measure prior to and after divalproex sodium initiation. Monotherapy, combination therapy with benzodiazepines and antipsychotics, and dose comparisons of divalproex sodium were studied.
In all three situations (i.e. as monotherapy, in combination with benzodiazepines and antipsychotics, and at both higher and lower doses), divalproex sodium therapy was shown to have multiple beneficial effects on various behavioural, mood and cognition indicators in elderly nursing home residents. In general, the data seemed to support more favourable results for the higher divalproex sodium dose group.
These data support the use of divalproex sodium in elderly nursing home residents with a history of dementia and behaviour problems and warrant conduct of prospective, randomised trials of the drug in this setting.
高达90%的痴呆症患者在病程的某个阶段会出现痴呆的行为和心理症状（BPSD）。BPSD会降低患者的生活质量，给护理人员带来极大困扰，并且是患者入住养老院的最常见原因。在养老院中，通常需要采取药物措施（通常是抗精神病药物或苯二氮䓬类药物）来控制痴呆症患者的激越和攻击行为。然而，美国食品药品监督管理局尚未批准任何药物用于这一适应症。抗癫痫药物丙戊酸钠在这种情况下可能具有优势，因为该患者群体中药物相互作用和不良反应的发生率较低。
本研究的目的是评估丙戊酸钠治疗对有与痴呆相关行为问题病史的老年养老院居民的行为、情绪和认知指标的影响。
本研究是对一个长期护理数据库的回顾性分析，该数据库可用于评估丙戊酸钠治疗对有痴呆相关行为问题病史的老年养老院居民的行为、情绪和认知指标的影响。在丙戊酸钠治疗的1年期间，收集治疗前后与行为、认知和情绪问题相关的最低数据集项目。采用两阶段广义线性回归，在丙戊酸钠开始使用时设置固定交叉点，以估计丙戊酸钠开始使用前后各指标的变化趋势。研究了单一疗法、与苯二氮䓬类药物和抗精神病药物的联合疗法以及丙戊酸钠剂量比较。
在所有三种情况下（即单一疗法、与苯二氮䓬类药物和抗精神病药物联合使用以及高剂量和低剂量），丙戊酸钠治疗均显示对老年养老院居民的各种行为、情绪和认知指标具有多种有益影响。总体而言，数据似乎支持丙戊酸钠高剂量组有更有利的结果。
这些数据支持在有痴呆病史和行为问题的老年养老院居民中使用丙戊酸钠，并证明有必要在这种情况下对该药物进行前瞻性、随机试验。
