Herrmann N
Department of Psychiatry, University of Toronto, Ontario.
Can J Psychiatry. 1998 Feb;43(1):69-72. doi: 10.1177/070674379804300108.
Valproic acid, an anticonvulsant medication that enhances GABAergic neurotransmission, has been shown to be helpful in treating behavioural disturbances associated with dementia in several small case series. In an attempt to further document its effectiveness and safety, valproic acid was used to treat a group of elderly patients with dementia and severe agitation.
Sixteen patients, aged 68 to 95 years, who were previously unresponsive to other pharmacotherapeutic interventions, were treated prospectively with open-label divalproex sodium. Effectiveness was measured with the Behave AD (B-AD), the Cohen-Mansfield Agitation Inventory (CMAI), and the Clinical Global Impression Scale (CGIS). Doses ranged from 750 to 2500 mg, divided, per day, with levels of 184 to 742 mumol/L.
Scores on the CMAI declined from 68.8 to 61.0 (P < 0.005), and scores on the B-AD declined from 15.8 to 12.3 (P < 0.004). On the CGIS, 1 patient was rated as very much improved, 3 patients were much improved, 4 patients were minimally improved, and 8 patients were unchanged. The drug was prematurely discontinued in only 1 patient because of side effects.
Valproic acid was shown to be well tolerated with modest effectiveness.
丙戊酸是一种增强γ-氨基丁酸能神经传递的抗惊厥药物，在几个小型病例系列研究中已显示对治疗与痴呆相关的行为障碍有帮助。为进一步证明其有效性和安全性，使用丙戊酸治疗一组患有痴呆和严重激越的老年患者。
16例年龄在68至95岁之间、先前对其他药物治疗干预无反应的患者，接受了开放标签的丙戊酸钠前瞻性治疗。采用Behave AD（B-AD）、科恩-曼斯菲尔德激越量表（CMAI）和临床总体印象量表（CGIS）来衡量有效性。剂量范围为每日750至2500毫克，分剂量服用，血药浓度为184至742微摩尔/升。
CMAI评分从68.8降至61.0（P < 0.005），B-AD评分从15.8降至12.3（P < 0.004）。在CGIS上，1例患者被评为显著改善，3例患者改善明显，4例患者稍有改善，8例患者无变化。仅1例患者因副作用提前停药。
丙戊酸显示出耐受性良好且有一定疗效。
