fluvoxamine and Dementia

Depression is a highly prevalent concomitant of dementia. Concurrent depression (DD) can meet full criteria for a disorder or take the form of a depressive syndrome. Although phenomenologic overlap can confound diagnosis, careful assessment demonstrates that a true depressive component is present in a substantial percentage of dementia cases. DD has been associated with excess disability, increased caregiver burden, and greater mortality. Efficacy studies have demonstrated high placebo response rates, indicating transience of many depressive symptoms, and adverse cognitive effects of older antidepressants. Studies demonstrating that new antidepressants can be efficacious and improve cognitive functioning are reviewed.

Topics: Aged; Aged, 80 and over; Antidepressive Agents, Tricyclic; Benzamides; Citalopram; Clomipramine; Cognition Disorders; Comorbidity; Dementia; Depression; Female; Fluoxetine; Fluvoxamine; Humans; Imipramine; Male; Middle Aged; Moclobemide; Monoamine Oxidase Inhibitors; Neuropsychological Tests; Nortriptyline; Selective Serotonin Reuptake Inhibitors; Sertraline

The descriptive term behavioral and psychological symptoms of dementia (BPSD) is used to cover a range of noncognitive disturbances including anxiety, depression, irritability, aggression, agitation, eating disorders, and inappropriate social or sexual behaviors. Behavioral and psychological symptoms of dementia are seen in about 90% of patients with dementia. We aimed to compare the efficacy and tolerability of risperidone, yokukansan, and fluvoxamine used for BPSD in elderly patients with dementia. Ninety inpatients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were investigated in Sato Hospital, Koutokukai. We conducted an 8-week, rater-blinded, randomized trial, administering flexibly dosed risperidone, yokukansan, or fluvoxamine. Primary outcome measures were Neuropsychiatric Inventory in Nursing Home Version total score and its items. Secondary outcome measures were cognitive function measured by Mini-Mental State Examination and daily life function measured by Functional Independence Measure (FIM). Neurological adverse effects were measured by the Drug-Induced Extra-Pyramidal Symptoms Scale. At the end of the study, we analyzed 76 patients (92.7%). Mean Neuropsychiatric Inventory in Nursing Home Version total score decreased in all 3 drug groups, with no significant between-group differences. Mini-Mental State Examination and Functional Independence Measure scores did not change significantly. Drug-Induced Extra-Pyramidal Symptoms Scale scores did not change in the yokukansan and fluvoxamine groups, but increased significantly in the risperidone group. Risperidone, yokukansan, and fluvoxamine were equally effective in the treatment of BPSD in elderly patients. However, yokukansan or fluvoxamine for BPSD showed a more favorable profile in tolerability compared with risperidone. This trial is registered at UMIN Clinical Trials Registry (identifier: UMIN000006146).

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Basal Ganglia Diseases; Central Nervous System Agents; Chi-Square Distribution; Dementia; Drugs, Chinese Herbal; Female; Fluvoxamine; Humans; Japan; Male; Multivariate Analysis; Psychiatric Status Rating Scales; Risperidone; Time Factors; Treatment Outcome

The efficacy of fluvoxamine on cognitive functioning and behavioral changes was evaluated in a double-blind, placebo-controlled study of 46 elderly demented patients. The patients had a DSM-III diagnosis of primary degenerative dementia or multi-infarct dementia and were aged greater than or equal to 65 years. Twenty-two patients were given 150 mg fluvoxamine per day and 24 received placebo tablets; 14 and 15 patients, respectively, completed 6 weeks of treatment. Within treatments, there were no significant changes in median scores on neuropsychological tests (picture recall and recognition, trail making and finger tapping) or the GBS scale scores (degrees of dementia) or GBS subscale score (clinical profiles, including symptoms common in dementia, motor, emotional and intellectual functioning). Between treatments, the median changes in psychometric test scores did not differ significantly. However, within and between treatments, there were trends favoring fluvoxamine on symptoms common in dementia (confusion, irritability, anxiety, fear-panic, mood level and restlessness). In conclusion, the study does not support the hypothesis that fluvoxamine improves cognitive functioning or behavioral changes in elderly dementia patients.

Topics: Aged; Aged, 80 and over; Dementia; Dementia, Multi-Infarct; Double-Blind Method; Female; Fluvoxamine; Humans; Male; Middle Aged; Neuropsychological Tests

The chronic effects of fluvoxamine (200 mg per day for 4 weeks) were studied in ten alcoholic organic brain syndrome patients in a double-blind cross-over design. Complete neuropsychological evaluation was performed as well as measurement of neurochemical changes in CSF. Fluvoxamine produced a small but significant improvement in memory performance. An analysis of fluvoxamine minus placebo difference scores showed a significant correlation between memory functioning and CSF 5HIAA levels. Alcohol amnestic syndrome patients who had the highest blood levels of fluvoxamine demonstrated the largest changes in CSF 5HIAA and improvement in memory performance under fluvoxamine. These findings implicate a role of serotonergic mechanisms in alcoholic organic brain syndrome and suggest that with individual titration of the drug dose, fluvoxamine might be a clinically useful agent in the treatment of this syndrome.

Topics: Aged; Alcohol Amnestic Disorder; Dementia; Double-Blind Method; Ethanol; Fluvoxamine; Humans; Hydroxyindoleacetic Acid; Middle Aged; Oximes; Substance-Related Disorders

Topics: Age of Onset; Aged; Anti-Anxiety Agents; Antipsychotic Agents; Aripiprazole; Dementia; Fluvoxamine; Humans; Male; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Quetiapine Fumarate; Self-Injurious Behavior; Tomography, Emission-Computed, Single-Photon

There have been no systematic efforts to manage and treat patients with frontotemporal dementia (FTD), but Perry described pharmacologic interventions for some behavioral syndromes in 2001. In Perry's report, selective serotonin reuptake inhibitors (SSRI) were recommended as first choice drugs because they were well tolerated and might have an effect on some symptoms such as compulsive symptoms and eating abnormalities. Some reports were presented concerning Japanese FTD patients which showed the effect of SSRI on stereotyped behaviors and eating abnormalities by Nishikawa, et al. (2001), Ikeda, et al. (2004), and others. We describe two FTD patients with compulsive complaints of pain, one mainly on abdomen and the other on lumbar region. Fluvoxamine markedly improved their complaints of pain as well as stereotyped symptoms. Fluvoxamine might be effective for behavioral disturbances due to improvement of serotoninergic dysfunction in frontal medial and cingulated cortices, as previously described. Moreover, it has been reported that an altered response to pain stimuli, either via a loss of awareness of pain or exaggerated reaction to pain, is a specific feature of FTD, but there have been only a few reports on this feature. Fluvoxamine might be effective for compulsive complaints of pain due to improvements of compulsive symptoms and exaggerated reactions to pain in FTD, or due to the analgesic effect of SSRI. SSRI may improve compulsive complaints of pain in FTD patients.

Topics: Aged; Compulsive Behavior; Dementia; Female; Fluvoxamine; Frontal Lobe; Humans; Middle Aged; Pain; Selective Serotonin Reuptake Inhibitors; Stereotyped Behavior; Temporal Lobe; Treatment Outcome

Topics: Animals; Atrophy; Cerebral Cortex; Chorea; Dementia; Dopamine Antagonists; Female; Fluvoxamine; Haloperidol; Humans; Isoindoles; Mice; Mice, Neurologic Mutants; Mice, Transgenic; Middle Aged; Piperazines; Pyrimidines; Receptors, Serotonin; Receptors, Serotonin, 5-HT1; Selective Serotonin Reuptake Inhibitors; Serotonin Receptor Agonists; Trinucleotide Repeat Expansion

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

Topics: Dementia; Feeding Behavior; Fluvoxamine; Humans; Hyperphagia; Male; Middle Aged; Oximes; Serotonin Antagonists