Effect of treatment with divalproex sodium and lorazepam in residents of long-term-care facilities with dementia-related anxiety or agitation: Retrospective chart review

Objective: The aim of this study was to compare the efficacy and safety of divalproex sodium with those of lorazepam in residents of long-term-care (L TC) facilities who had documented diagnoses of dementia with agitation or a nxiety. Background: Anxiety and agitation are frequent behavioral complications of Alzheimer's disease that increase the costs and emotional stress associated with caring for these patients. Methods: LTC facilities in New Jersey and Pennsylvania were identified for 60 days of retrospective medical chart review, Patients with documented dem entia and behavioral disturbances were screened to identify the use of diva lproex sodium or lorazepam, Diagnoses of dementia with agitation or dementi a with anxiety were confirmed through physicians' notes on history and phys ical examinations. Data collected included dose, drug blood levels, adverse events, and efficacy. The chart review did not control for other medicatio ns that might cause anxiety or agitation. Because this was a retrospective study, there was no random allocation of patients for statistical analysis, A MEDLINE(R) search was done on the effects of benzodiazepines in the elde rly, Results.. The charts of 146 patients (81, lorazepam; 65, divalproex sodium) in 60 long-term-care facilities were reviewed. Behavioral improvement occu rred in 25 patients (30.9%) treated with lorazepam, compared with 37 patien ts (56.9%) treated with divalproex sodium (P < 0.05), Weight loss (50.6%) a nd falls (40.7%) were the most common adverse events in the lorazepam-treat ed group; lorazepam was discontinued in 7 patients (8.6%) because of advers e events. Weight gain in 32 patients (49.2%) was the most common adverse ev ent in the divalproex sodium group. There was 1 fall (1.5%) in the divalpro ex sodium group, and no patient required discontinuation of divalproex sodi um treatment. Increased liver function test values in 7 divalproex sodium-t reated patients (10.8%) were transient and did not require discontinuation of treatment. Conclusions: Despite being short term and small, the present; study suggest s that divalproex sodium may be more effective and safer than lorazepam for the treatment of agitation or anxiety related to dementia in LTC facility residents. Larger, longer-term controlled studies are recommended to furthe r assess these results.