A warm soak in the tub should
be a relaxing ritual, but for Ruby Lee, 57, and her mother
Myra, 82, it's a draining ordeal. Myra suffers from Alzheimer's
and becomes agitated and angry when bath time rolls around.
A presentation at the recent International Conference
on Alzheimer's Disease and Related Disorders in Philadelphia
detailed how quetiapine can control agitation in elderly
people who have Alzheimer's. As an added bonus, this relief
does not come at the price of an increased risk of stroke
or other side effects.
While some research has demonstrated
the usefulness of other antipsychotic drugs, this more
rigorous prospective, randomized and placebo-controlled
study, headed by Dr Pierre Tariot of the University
of Rochester, allowed the effect of quetiapine to be
definitively teased out from the influences of other
factors.
The study involved 333 mainly female
nursing home residents with a mean age of 83 who were
thought to have Alzheimer's and/or brain damage induced
by strokes. In addition, all the subjects were clinically
agitated, as defined using two well-known scoring systems.
These participants were randomly
selected to receive an eight-day treatment consisting
of daily doses of 100mg quetiapine (124 people), 200mg
(117 people) or a placebo (92 people). Participants
did not know if they were getting the real deal or not.
Agitation was scored during the
treatment period and for up to 10 weeks. Only three
people did not finish the eight-day treatment, while
two-thirds of the participants completed the 10-week
study.
The researchers found that the
200mg per day dose of quetiapine reduced people's agitation
to an extent that was statistically significant. The
lower dose of the drug also quelled agitation, but not
to the same degree. The advantages of quetiapine did
not come at the price of increased falls or commonly
encountered downsides like urinary tract infections,
confusion and general tiredness. Nor was there any evidence
of altered brain function, which can occur with other
antipsychotic drugs.
Despite this bounty of good news,
Dr Tariot was quick to advise conference delegates not
to push drugs as the regular go-to strategy rush in
nursing homes. "I think pharmacological interventions
should be the last choice in treating agitation � not
the first choice," he said.
Currently, quetiapine is licensed
in many countries, including Canada, to treat psychotic
disorders such as schizophrenia. Its potential for use
in easing agitation would be welcome news to the estimated
364,000 Canadians with Alzheimer's or related dementia.
Agitation occurs in about half of Alzheimer's patients
at some point in their illness, and is "one of the major
reasons many families end up placing their loved ones
in nursing homes," stated Dr Tarot.
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