Carbamazepine treatment of agitation in nursing home patients with dementia: a preliminary study.

OBJECTIVE

To determine the effects of carbamazepine versus placebo on ratings of behavior in agitated nursing home patients with dementia.

DESIGN

Nonrandomized, placebo-controlled, crossover trial conducted in 25 patients in two nursing homes.

INTERVENTION

Carbamazepine and placebo were administered during two 5-week periods separated by a 2-week washout. The carbamazepine dose was determined for each patient by a nonblinded physician who did not participate in ratings (modal dose 300 mg/day).

MEASUREMENTS

The primary outcome measures were Brief Psychiatric Rating Scale scores and Clinical Global Impression of Change, rated by blind observers. Secondary measures of behavior, adversity, cognition, and functional status were also included.

MAIN RESULTS

Median total Brief Psychiatric Rating Scale score decreased 7 points on carbamazepine versus 3 on placebo (P = 0.03). Sixteen subjects were rated as improved globally on carbamazepine versus four on placebo (P = 0.001). Secondary measures of behavior showed similar changes at significant or suggestive (P < 0.10) levels. One subject developed carbamazepine-induced tics, and one died with a pneumonia. There was minimal other adversity.

CONCLUSION

This preliminary study suggests that carbamazepine in low doses can reduce agitated behaviors in some patients, with limited adversity resulting. Further research is required to confirm and extend this finding before it can be considered routine clinical practice.