LOW-DOSE PROPRANOLOL REDUCES AGGRESSION AND AGITATION RESEMBLING THATASSOCIATED WITH ORBITOFRONTAL DYSFUNCTION IN ELDERLY DEMENTED PATIENTS

Although several reports suggest that intermediate to high doses of pr opranolol (80-160 and 200-600 mg/day) can effectively treat aggressive behavior in dementia, significant side effects can occur at these dos es. To minimize these side effects, we treated and followed-up a serie s of 12 demented patients, whose caregivers sought medical help for th eir disruptive, aggressive behavior, with low-dose propranolol monothe rapy (10-80 mg/day). Assessment measures obtained at baseline and duri ng treatment by caregiver interview included ordinal ratings of aggres sion severity, the Cohen-Mansfield Agitation Inventory (CMAI), and the California Behavior Questionnaire (CBQ). The aggression ratings showe d that low-dose propranolol effectively reduced aggression in eight of 12 patients (67%) within 2 weeks of treatment and remained effective for the duration of follow-up (1 to 14 months). Subscales of the CMAI showed responders to have significant reductions in physical and verba l aggression/agitation and in pacing/wandering. These results suggest that low-dose propranolol should be further studied for treating aggre ssion or agitation in demented patients.