fluvoxamine and Dementia--Vascular

It has been reported that 20-65% of cerebral infarction patients suffers from depression. On the other hand, elderly-onset depression has more cerebro-vascular changes such as deep white matter lesion and periventricular hyperintensity on MRI than young-onset depression. These findings together leads new disease category 'vascular depression' (VD), meaning depression primarily caused by cerebral infarction. VD patients show less family history and symptomatic changes within a day than those with non-vascular depression. Though anti-depressants are effective on VD, they have higher incidence of side effect on VD than on non-vascular depression. Benzodiazepines and cerebral circulation and metabolism enhancers are also used in VD therapy. The prognosis of VD is worse than that of non-VD or cerebral infarction without depression.

Topics: Antidepressive Agents, Second-Generation; Dementia, Vascular; Diagnosis, Differential; Fluvoxamine; Humans; Magnetic Resonance Imaging; Prognosis; Selective Serotonin Reuptake Inhibitors

To describe the effects of treatment with the selective serotonin reuptake inhibitor fluvoxamine on three patients with advanced dementia who developed a stereotypic movement disorder.. Three patients in a skilled nursing facility were referred by their primary physicians for psychiatric consultation to assist with the management of stereotypic behaviors. The patients received a standard medical, neurologic, and psychiatric workup for dementia. Two of the patients were diagnosed with dementia of the Alzheimer type and the other patient was diagnosed with vascular dementia. All three patients were started on fluvoxamine 25 mg/d; behaviors were monitored daily by the nursing staff and their primary care physicians and weekly by their psychiatrist using the Abnormal Involuntary Movement Scales. The dosage was titrated upward weekly to a maximum dosage of 150 mg/d.. Two patients showed complete resolution of their stereotypic behaviors by week 6. The third patient showed noticeable improvement with some residual movements after 8 weeks of treatment.. Fluvoxamine appeared effective in the control of stereotypic behaviors in three patients with advanced dementia.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Dementia; Dementia, Vascular; Female; Fluvoxamine; Humans; Selective Serotonin Reuptake Inhibitors; Stereotyped Behavior