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Valproate preparations for agitation in dementia.
Edmund Lonergan1, Jay Luxenberg
14 Captain Drive, Apt 215, Emeryville, CA, USA, 94608.
The Cochrane Database of Systematic Reviews
|July 10, 2009
Summary
Valproate preparations are ineffective for treating agitation in dementia patients and are associated with unacceptable adverse effects. Further research is needed, and current evidence does not support valproate therapy for dementia agitation.
Area of Science:
- Geriatric Medicine
- Psychopharmacology
- Evidence-Based Medicine
Background:
- Agitation is a common and challenging symptom in up to 70% of older adults with dementia.
- Valproic acid derivatives have been used for a decade to manage agitation in dementia, yet robust systematic reviews on their efficacy are lacking.
- Previous reviews have been limited by small sample sizes and methodological concerns.
Purpose of the Study:
- To systematically review and synthesize evidence on the effectiveness of valproate preparations for treating agitation in individuals with dementia.
- To evaluate the safety and adverse effects associated with valproate therapy in this population.
Main Methods:
- A comprehensive search of multiple databases including Cochrane Dementia and Cognitive Improvement Group (CDCIG) Register, MEDLINE, EMBASE, PsycINFO, CINAHL, and LILACS was conducted.
- Inclusion criteria focused on randomized, placebo-controlled trials with concealed allocation that assessed agitation and dementia.
- Data extraction and meta-analysis were performed, including intention-to-treat analyses, comparing valproate treatment with control groups.
Main Results:
- Initial meta-analyses were limited by methodological issues in included trials, such as lack of concealed allocation, high dropout rates, and questionable statistical analyses.
- An updated review incorporating two new studies (2005, 2007) found no significant improvement in agitation for patients treated with valproate compared to controls.
- The updated analysis revealed an increased incidence of adverse events, including falls, infections, and gastrointestinal disorders, in the valproate group.
Conclusions:
- The updated systematic review confirms that valproate preparations are ineffective for managing agitation in dementia patients.
- Valproate therapy is associated with a high rate of adverse effects, making it an unfavorable treatment option.
- Current evidence does not support the use of valproate for agitation in dementia, and further research is warranted.
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