Tariot et al65 assessed the efficacy, safety, and tolerability of carbamazepine in the treatment of agitation and aggression associated with severe dementia in a placebocontrolled trial. Clinical Global Impression (CGI) ratings showed global improvement, in 77% of the patients taking carbamazepine and 21 % of those taking placebo. The mean daily dose of carbamazapine at week 6 was 304 mg/day (SD=119) with a mean serum level of 5.3 ug/mL. The drug was generally well tolerated. Divalproex sodium with an average dose at week 6 of 826 mg/day (375–1.375 mg/day with an average level of 45 μg/mL) has been shown superior to placebo (reduced agitation on the Inhibitors,research,lifescience,medical CGI in 68% of patients on valproate vs 52% on placebo; P=0.06).

Side effects were generally rated as mild. These data suggest that anticonvulsants might, be a helpful strategy in the treatment of agitation and aggression in dementia. Inhibitors,research,lifescience,medical However, further placebo-controlled trials are required to explore the clinical efficacy and tolerability of these compounds, particularly of the new generation of anticonvulsants. Because aggressive patients do not always respond to medication (single drug or in combination), one-to-one nursing in a quiet room is sometimes indicated.

Sleep disturbances Sleep disturbances in AD patients are characterized by fragmented sleep or disruption in the day–night sleep Inhibitors,research,lifescience,medical cycle.8 They appear to become progressively worse as the disease progresses, although

the Vorinostat severity of this disturbance varies considerably among individual patients. Apart from the neurodegenerative disease process itself, various other factors Inhibitors,research,lifescience,medical may influence the quality of sleep including physical or environmental conditions and drug side effects. Pharmacological conditions and drug side effects. Pharmacologically, chloralhydrate Inhibitors,research,lifescience,medical (250–1000 mg/24 hours), new nonbenzodiazepine hypnotics, such as Zolpidem (5–10 mg at night), an imidazopyridine derivative, zopiclonc (3.75–7.5 mg at night), a cyclopyrrolone-dcrivative, and low-potency neuroleptics (eg,melperone 25–75 mg at night) have been found effective.20 Trazodone, a sedative antidepressant agent with anxiolytic properties and minor anticholinergic effects improves sleep disorders (25–75 mg). However, some patients may develop hypotension. Anxiety Anxiety occurs in 50% to 80% of patients with AD.7,9,13 However, in contrast to agitation, aggression, psychosis, and depression, anxiety has been less well studied in patients with Carfilzomib dementia. Anxiety and depression coexist and overlap with various symptoms, such as agitation and the awareness of the cognitive deficiencies with resulting helplessness. The etiology and pathophysiology of anxiety in AD is not well understood. There is evidence that, anxiety is associated with loss of serotonergic neurons in AD. Antidepressants enhancing serotonergic activity, particularly SSRIs, may improve depression and anxiety.