Title:Efficacy of Sodium Valproate in Behavioral and Psychological Symptoms of Dementia: A Retrospective Observational Study from PUMCH Dementia Cohort
Volume: 22
Issue: 5
Author(s): Yuyue Qiu, Li Shang, Tianyi Wang, Yuhan Jiang, Jialu Bao, Wenjun Wang, Bo Li, Yixuan Huang, Liling Dong, Chenhui Mao*Jing Gao*
Affiliation:
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital Translational Medical Center, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital Translational Medical Center, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China
Keywords:
Dementia, behavioral and psychological symptoms, aberrant motor behavior in dementia, dementia agitation, psychomotor agitation, aggression, valproic acid.
Abstract:
Introduction: Behavioral and Psychological Symptoms of Dementia (BPSD) pose significant
challenges for individuals with dementia and their caregivers. Agitation symptoms, in particular, present
a complex management dilemma as there is a lack of consensus regarding pharmacotherapy, specifically
with respect to the controversial use of valproate formulations. This study aims to assess the effectiveness
of valproate treatment in addressing BPSD, with a specific focus on managing agitation symptoms
in individuals with dementia.
Methods: A retrospective analysis was conducted at Peking Union Medical College Hospital (PUMCH)
on patients diagnosed with BPSD who received valproate formulations between 2013 and 2023. Patients
were classified into 'effective,' 'ineffective,' and 'unknown' groups based on their response to valproate
treatment, and the distribution of BPSD symptoms between the effective and ineffective groups
was compared.
Results: Among the 116 patients studied, 62.1% exhibited effective responses, 12.1% showed ineffectiveness,
and 25.9% had uncertain outcomes with valproate therapy. While the effective group displayed
a higher prevalence of agitation symptoms and other behaviors like wandering, restricted and
repetitive behaviors, and sleep disturbances compared to the ineffective group, these differences did not
reach statistical significance (p = 0.156, 1.000, 0.899, 0.283). Patients in the ineffective group were
more likely to experience aggression with comorbid psychotic symptoms compared to those in the effective
group (p = 0.023).
Discussion: Valproate may benefit agitation-predominant BPSD without psychosis. Discrepancies in
prior findings may stem from differing dosing strategies. Its limited efficacy in psychosis-related aggression
underscores the need for careful clinical evaluation.
Conclusion: The findings suggest that tailored valproate treatment at low doses may be beneficial in managing
agitation without psychosis in Asian BPSD patients. Further validation through randomized controlled
trials is essential to substantiate these observations.
