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Agitation is common among older adults with dementia; its origin may be multi-factorial, and it is often difficult to treat. In this paper, we summarize current knowledge and offer considerations on pharmacologic management of behavioral and psychological symptoms of dementia (BPSD). Several case reports describe using gabapentin, an anti-epileptic and FDA-approved treatment for neuropathic pain, as an off-label treatment for BPSD. BPSD in some patients may be driven by unreported neuropathic pain, which gabapentin can treat effectively. We present the case of a patient with incipient vascular dementia accompanied by nocturnal agitation, which was successfully treated with gabapentin. Gabapentin appears to be useful and well-tolerated in this indication. The effect of gabapentin and pregabalin on agitation in dementia: Case series of ten patients Rev Neurol (Paris) . 2024 Jun;180(6):559-563. doi: 10.1016/j.neurol.2023.11.006. A series of case reports have described the treatment of patients with dementia with agitation using gabapentin and showed that the patients responded to the treatment favorably [187, 188]. Currently, gabapentin is being investigated in a phase IV study (NCT03082755) to test its effect (300–600 mg/day) on night-time agitation (primary outcome Which medications are effective at decreasing agitation in patients with dementia? Selective serotonin reuptake inhibitors (SSRIs) and risperidone (Risperdal) are moderately effective Rating Anxiety in Dementia Scale (6). Following this intervention, subsequent episodes of agitation were limited to delirium, especially during UTIs. The second case is a 97-year-old male with mixed Alzheimer’s and vascular dementia who continued to have breakthrough agitation despite being treated with trazodone 25mg nightly. Complementing this formal systematic review, an illustrative case of a patient with BPSD in mixed Alzheimer's/vascular dementia, who appeared to derive benefits in terms of symptom control and functioning from the introduction of gabapentin titrated up to 3600 mg day-1 alongside other interventions, is presented. The authors describe the use of gabapentin in the treatment of 4 outpatients with dementia-associated agitation. On the basis of clinical case reports and the Overt Agitation Severity Scale, all 4 patients had reduced agitation with gabapentin. Following PRISMA guidelines, we systematically reviewed evidence for gabapentin and pregabalin against BPSD symptoms of agitation or aggression in any dementia, using six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science). We would like to show you a description here but the site won’t allow us. In 2011, a case report described the effectiveness of gabapentin in reducing the dementia-associated nocturnal agitation . Gabapentin is an FDA-approved drug for the treatment of epilepsy [ 182 ]. Gabapentin blocks the α2δ subunit-containing voltage-dependent calcium channels (Fig. 10 ), which are associated with the release of In most of the reviewed cases, gabapentin was reported to be a well tolerated and effective treatment for BPSD. However, two case reports in which gabapentin was used in the context of agitation in dementia with Lewy bodies questioned the appropriateness of gabapentin for all types of dementia-related agitation. The newer anticonvulsants gabapentin and lamo-trigine are being studied with this population. To date, little evidence is available on their use in treating agitation in patients with dementia, although there is evidence of their usefulness in other patient populations for agitation (37–40). They are to be used with caution. The authors describe the use of gabapentin in the treatment of 4 outpatients with dementia-associated agitation. On the basis of clinical case reports and the Overt Agitation Severity Scale, all 4 patients had reduced agitation with gabapentin. Three of 4 patients were successfully titrated to a full dose of 2,400mg/day. These findings suggest a possible role for gabapentin in the behavioral This observational study was conducted to evaluate the effects of gabapentinoids (gabapentin and pregabalin) on agitation in patients with dementia and to document any adverse effects. severe dementia with Lewy bodies. Findings: Improvement in symptoms seen by clinician and caregivers supported by changes on respective scales. Message: Preliminary positive evidence suggesting that low dose gabapentin can be used for treatment of patients with dementia with Lewy bodies. Purpose: To evaluate low dose Gabapentin (GBP) for In a 24-patient case series from retrospective chart review, the authors examined the use of gabapentin for the treatment of aggressive and agitated behaviors in nursing home patients with a DSM-IV diagnosis of dementia. The authors describe the use of gabapentin in the treatment of 4 outpatients with dementia-associated agitation. On the basis of clinical case reports and the Overt Agitation Severity Scale, all 4 patients had reduced agitation with gabapentin. Three of 4 patients were successfully titrated to a ful Neuropsychiatric symptoms are common in dementia, but may be under-reported by patients and families . Screening for agitation and other neuropsychiatric symptoms in patients with dementia should be done at regular follow-up visits . We ask both caregivers and patients explicit questions regarding such symptoms, for example, "Does the patient
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