One of the most, recent studies was conducted by Tariot and colleagues.57 Using a nonrandomized, placebo-controlled, crossover design in 25 agitated patients, carbamazepine and placebo were administered during two 5-week periods, separated by a 2-wcek washout period. The carbamazepine dose was determined by a nonblinded physician (modal dose was 300 mg/day).

This study included 25 subjects, and outcome measures showed significant decrease in overall agitation as determined by the BPRS (P=0.03) as well as in measures of global improvement. (P=0.001).The authors concluded that carbamazepine could be a useful tool for the treatment, of agitation in this patient, population. Inhibitors,research,lifescience,medical SB590885 cell line valproic acid could also be useful in these patients, Inhibitors,research,lifescience,medical as described in the literature,58,59 although large-scale double-blind studies are lacking. Side effects from mood stabilizers, such as sedation, confusion, and ataxia, should be clinically monitored. Routine laboratory tests should be performed during treatment with carbamazepine (eg, blood cell count for bone marrow suppression, electrolytes Inhibitors,research,lifescience,medical for hyponatremia, drug levels for toxicity) and valproic acid (eg, liver function tests for hepatotoxicity, drug levels for toxicity) in demented patients with agitation. The use of lithium carbonate in the elderly is limited due to the risks of inducing delirium,60 particularly in the medically-

compromised patient. Schneider et al61 found that lithium carbonate was effective only in one in Inhibitors,research,lifescience,medical six patients with AD and aggressive behavior. The literature suggests62,63 that lithium can be considered in cases where aggressive behavior is related to mood instability. Nonpharmacological interventions Historically, older adults have not been considered good candidates for nonpharmacological, psychotherapeutic interventions.64 However, an increasing number of researchers have studied the psychosocial issues confronting aging adults, and their response to

individual and group therapies.65 Literature reviews relating to specific psychotherapeutic interventions with elderly Inhibitors,research,lifescience,medical patients are available and include the behavioral Parvulin assessment and treatment of anxiety, reduction in insomnia, behavioral management, of dementia, the use of reminiscence therapy, and group family caregiver interventions.66-69 A detailed literature review of BPSD patients demonstrated that most, studies are of a pharmacological type and that there are few systematic studies of behavioral or environmental interventions.70,71 The existing studies rarely specify a syndrome. These studies often relate to specific behaviors, such as wandering, or to treatments recommended for a given stage of dementia. For this reason, in this section wc will depart, from the previously used syndromal model and review nonpharmacological interventions as a group.