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Randomized Controlled Trial
. 2014 Feb 19;311(7):682-91.
doi: 10.1001/jama.2014.93.

Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial

Anton P Porsteinsson  1 , Lea T Drye  2 , Bruce G Pollock  3 , D P Devanand  4 , Constantine Frangakis  2 , Zahinoor Ismail  5 , Christopher Marano  6 , Curtis L Meinert  2 , Jacobo E Mintzer  7 , Cynthia A Munro  6 , Gregory Pelton  8 , Peter V Rabins  6 , Paul B Rosenberg  6 , Lon S Schneider  9 , David M Shade  2 , Daniel Weintraub  10 , Jerome Yesavage  11 , Constantine G Lyketsos  6 ; CitAD Research Group
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Randomized Controlled Trial

Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial

Anton P Porsteinsson et al. JAMA. .

Abstract

Importance: Agitation is common, persistent, and associated with adverse consequences for patients with Alzheimer disease VSports手机版. Pharmacological treatment options, including antipsychotics are not satisfactory. .

Objective: The primary objective was to evaluate the efficacy of citalopram for agitation in patients with Alzheimer disease. Key secondary objectives examined effects of citalopram on function, caregiver distress, safety, cognitive safety, and tolerability. V体育安卓版.

Design, setting, and participants: The Citalopram for Agitation in Alzheimer Disease Study (CitAD) was a randomized, placebo-controlled, double-blind, parallel group trial that enrolled 186 patients with probable Alzheimer disease and clinically significant agitation from 8 academic centers in the United States and Canada from August 2009 to January 2013. V体育ios版.

Interventions: Participants (n = 186) were randomized to receive a psychosocial intervention plus either citalopram (n = 94) or placebo (n = 92) for 9 weeks. Dosage began at 10 mg per day with planned titration to 30 mg per day over 3 weeks based on response and tolerability VSports最新版本. .

Main outcomes and measures: Primary outcome measures were based on scores from the 18-point Neurobehavioral Rating Scale agitation subscale (NBRS-A) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC). Other outcomes were based on scores from the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory (NPI), ability to complete activities of daily living (ADLs), caregiver distress, cognitive safety (based on scores from the 30-point Mini Mental State Examination [MMSE]), and adverse events. V体育平台登录.

Results: Participants who received citalopram showed significant improvement compared with those who received placebo on both primary outcome measures. The NBRS-A estimated treatment difference at week 9 (citalopram minus placebo) was -0. 93 (95% CI, -1. 80 to -0. 06), P = . 04. Results from the mADCS-CGIC showed 40% of citalopram participants having moderate or marked improvement from baseline compared with 26% of placebo recipients, with estimated treatment effect (odds ratio [OR] of being at or better than a given CGIC category) of 2. 13 (95% CI, 1. 23-3. 69), P = VSports注册入口. 01. Participants who received citalopram showed significant improvement on the CMAI, total NPI, and caregiver distress scores but not on the NPI agitation subscale, ADLs, or in less use of rescue lorazepam. Worsening of cognition (-1. 05 points; 95% CI, -1. 97 to -0. 13; P = . 03) and QT interval prolongation (18. 1 ms; 95% CI, 6. 1-30. 1; P = . 01) were seen in the citalopram group. .

Conclusions and relevance: Among patients with probable Alzheimer disease and agitation who were receiving psychosocial intervention, the addition of citalopram compared with placebo significantly reduced agitation and caregiver distress; however, cognitive and cardiac adverse effects of citalopram may limit its practical application at the dosage of 30 mg per day V体育官网入口. .

Trial registration: clinicaltrials. gov Identifier: NCT00898807. VSports在线直播.

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Figures

Figure 1
Figure 1
Participant flow, CONSORT diagram
Figure 2
Figure 2. Neurobehavioral Rating Scale (NBRS) – agitation subscore
Higher NBRS scores indicate more severe symptoms. The middle bar of the boxes represents the median; the star in the box represents the mean; the lower and upper ends of the boxes are the first and third quartiles, respectively. The whiskers represent values within 1.5 times the inter-quartile range from the upper or lower quartile (or the minimum and maximum if within 1.5 times the interquartile range of the quartiles) and data more extreme than the whiskers are plotted individually as outliers.
See this image and copyright information in PMC

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References (VSports最新版本)

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