Treatment of Dementia With Behavioral Disturbance Using Divalproex or a Combination of Divalproex and a Neuroleptic

Background: Neuroleptics have been used extensively to treat noncognitive behavioral disturbances in dementia, although their efficacy is only moderate and side effects are prominent. This study aims to determine the efficacy and tolerability of the non-neuroleptic divalproex sodium in patients with dementia and behavioral problems.

Method: Charts of consecutive inpatients with dementia and behavioral problems according to DSM-IV were retrospectively reviewed. Patients treated with divalproex were analyzed for dosage, duration of divalproex treatment, levels, efficacy, side effects, and concurrent medications. Target behavioral symptoms were identified, and change was rated using a Clinical Global Impressions (CGI)-Severity of Illness scale. Patients who were much or very much improved were considered to be responders.

Results: Twenty-five patients (15 men and 10 women) with a mean±SD age of 77±7 years were identified. Fourteen (56%) of the 25 patients met our criteria for response after the addition of divalproex. Divalproex given alone was effective in 7 of 15 patients. Divalproex was added to an ongoing neuroleptic in 10 patients, and 7 patients responded. Patients received a mean final divalproex dose of 1650 mg/day with a mean blood level of 64 mg/mL. Divalproex was well tolerated in this population except for reversible sedation in 8 patients and transient worsening gait and confusion in 1 subject.

Conclusion: Divalproex appeared to be as effective as previously reported rates for neuroleptics in the treatment of behavioral disturbances in dementia. The combination of divalproex and a neuroleptic was effective in patients who had failed either agent administered independently.