Medication for Agitation is Ineffective or Dangerous

Research findings for quetiapine and rivastigmine
Feburary 2005

Quetiapine (Seroquel) and rivastigmine (Exelon) prescribed to control behavioral changes that occur in Alzheimer's have been found to be ineffective in treating agitation. Quetiapine was found to actually speed up some people's rate of cognitive decline, that is, people's ability to process new information, memory function, problem solving etc.

The research, reported in the British Medical Journal, was carried out by a team headed by Clive Ballard of the Institute of Psychiatry at Kings College, London. It studied 93 people with Alzheimer's disease for 6 months. All were residents of nursing homes in North East England. The 93 patients were divided into three groups and treated with either quetiapine, rivastigmine or a placebo. The researchers assessed their levels of agitation and cognitive abilities at six weeks and twenty-six weeks.

Research Findings
Forty-six patients completed cognitive assessments after six weeks.

Overall the study participants showed no benefit to their symptoms of agitation over a six month timeframe taking either types of medication, Quetiapine (Seroquel) and rivastigmine (Exelon) or the placebo.

The 14 people suffering from Alzheimer's disease and agitation who were taking quetiapine showed an average drop of around 14.6 points on the scale used to assess cognitive decline.

Those study subjects taking rivastigmine showed little or no worsening of their illness.

Those taking the placebo, the dummy pill, showed some changes.

The research highlights concerns over long term use of antipsychotic medication in Alzheimer's patients.

The researchers conclusions were 'Neither quetiapine nor rivastigmine are effective in the treatment of agitation in people with dementia in institutional care. Compared with placebo, quetiapine is associated with significantly greater cognitive decline'.

What the Drug Company says
A spokesman for AstraZeneca is quoted as pointing out that quetiapine has been shown to be a safe and effective medication used in the treatment of over eight million people since 1997. He thought the sample was too small for any 'conclusions about the drug's effect on cognitive decline to be made' and that research findings on five patients had 'disproportionately influenced the results' .

Concerns of Quetiapine (Seroquel) another Blow for the Treatment of Agitation in Alzheimer's
Even given the small size of the study group, the findings are a blow to those treating people with Alzheimer's disease who experience agitation, a distressing yet pretty common symptom. Neither Quetiapine (Seroquel) or rivastigmine (Exelon) appear to help. Quetiapine appears detrimental as it accelerates cognitive decline in people with clinically significant agitation in Alzheimer's. Risperidone and olanzapine, two other antipsychotic medications are already under scrutiny as they appear to increase the risk of stroke.