Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2012 Apr;28(4):185-93. doi: 10.1016/j.kjms.2011.10.025. Epub 2012 Feb 14.
Behavioral and psychological symptoms of dementia (BPSD) are common and debilitating problems, but current treatments are limited. Antipsychotic agents show some efficacy on BPSD, but their use is limited by the associated risk of cerebrovascular events and mortality. Reports have shown the efficacy of mood stabilizers on BPSD, but systemic reviews on this issue are scant. This article aims to review studies of the efficacy of mood stabilizers on BPSD, and the quality of the available evidence. We searched for articles published in English during the period 1990 to 2010 and included in the PubMed database that concerned treatment of BPSD with mood stabilizers, such as carbamazepine, valproate, gabapentin, topiramate, lamotrigine, oxcarbazepine and lithium. The quality of the studies was assessed by considering the trial designs, analyses, subjects and results. We found one meta-analysis and three randomized controlled trials (RCTs) supporting the efficacy of carbamazepine in managing global BPSD, particularly aggression and hostility. With regard to valproate, current evidence from one meta-analysis and five RCTs did not strongly support its efficacy for global BPSD, including agitation and aggression. Only open trials or case series showed some efficacy of gabapentin, topiramate and lamotrigine in controlling BPSD. The single RCT investigating the effect of oxcarbazepine on agitation and aggression showed negative results. Case series reports on lithium tended to show it to be ineffective. Thus far, among mood stabilizers, carbamazepine has the most robust evidence of efficacy on BPSD. More RCTs are needed to strengthen evidence regarding the efficacy of gabapentin, topiramate and lamotrigine. Valproate, oxcarbazepine and lithium showed low or no evidence of efficacy. Large and well designed RCTs focusing on specific symptoms of BPSD are needed to deal with the issue.
痴呆的行为和心理症状（BPSD）是常见且使人虚弱的问题，但目前的治疗方法有限。抗精神病药物对 BPSD 显示出一定的疗效，但由于与脑血管事件和死亡率相关的风险，其使用受到限制。有报道显示心境稳定剂对 BPSD 的疗效，但关于这个问题的系统评价很少。本文旨在综述心境稳定剂治疗 BPSD 的疗效研究，并评价现有证据的质量。我们检索了 1990 年至 2010 年期间在 PubMed 数据库发表的英文文章，这些文章涉及使用卡马西平、丙戊酸盐、加巴喷丁、托吡酯、拉莫三嗪、奥卡西平和锂等心境稳定剂治疗 BPSD。研究质量的评估考虑了试验设计、分析、对象和结果。我们发现一项 meta 分析和三项随机对照试验（RCT）支持卡马西平治疗 BPSD 的总体疗效，特别是对攻击性和敌意。关于丙戊酸盐，目前一项 meta 分析和五项 RCT 的证据并不强烈支持其对 BPSD 总体疗效，包括激越和攻击。只有开放试验或病例系列报告显示加巴喷丁、托吡酯和拉莫三嗪对控制 BPSD 有一定疗效。唯一一项关于奥卡西平对激越和攻击影响的 RCT 显示出阴性结果。锂的病例系列报告倾向于显示其无效。到目前为止，在心境稳定剂中，卡马西平对 BPSD 的疗效证据最充分。需要更多的 RCT 来加强加巴喷丁、托吡酯和拉莫三嗪疗效的证据。丙戊酸盐、奥卡西平和锂的疗效证据不足或无效。需要进行大型、设计良好的 RCT，重点关注 BPSD 的特定症状，以解决这一问题。
