This is an interesting study but has some limitations, which make it
difficult to interpret the results. These limitations are:
1. Agitation is not defined and can mean a number of things.
Agitation is a broad term and includes verbal or physical aggression,
oppositional behavior, crying etc. This makes it difficult to interpret
the results e.g. if a patient who is physically aggressive after treatment
with a medication or placebo stops being physically aggressive but instead
becomes oppositional and non-compliant, he/she will have shown improvement
but would still be considered "agitated".
2. A lot of times the "agitation" is secondary to psychosis,
delirium, pain, worsening of physical condition and infections. Unless
these underlying/comorbid conditions are treated the response to treatment
for agitation is not good. Again we don't know if patients in each of the
three groups had any comorbid conditions. In particular psychosis is a
predictor of poor outcome.
3. It would have been interesting if higher doses of quetiapine were
used as some open label studies done in USA showed effectiveness of
quetiapine for treatment for behavioral disturbances in dementia when
higher doses (>200mg/day) were used.
Competing interests:
None declared
Competing interests:
No competing interests
09 March 2005
Zafeer H.K Barki
Staff Psychiatrist at Birmingham VA Medical Center
Rapid Response:
Agitation in patients with dementia
This is an interesting study but has some limitations, which make it difficult to interpret the results. These limitations are:
1. Agitation is not defined and can mean a number of things. Agitation is a broad term and includes verbal or physical aggression, oppositional behavior, crying etc. This makes it difficult to interpret the results e.g. if a patient who is physically aggressive after treatment with a medication or placebo stops being physically aggressive but instead becomes oppositional and non-compliant, he/she will have shown improvement but would still be considered "agitated".
2. A lot of times the "agitation" is secondary to psychosis, delirium, pain, worsening of physical condition and infections. Unless these underlying/comorbid conditions are treated the response to treatment for agitation is not good. Again we don't know if patients in each of the three groups had any comorbid conditions. In particular psychosis is a predictor of poor outcome.
3. It would have been interesting if higher doses of quetiapine were used as some open label studies done in USA showed effectiveness of quetiapine for treatment for behavioral disturbances in dementia when higher doses (>200mg/day) were used.
Competing interests: None declared
Competing interests: No competing interests