Dronabinol for the Treatment of Agitation and Aggressive Behavior in Acutely Hospitalized Severely Demented Patients with Noncognitive Behavioral Symptoms
Woodward et al.·The American Journal of Geriatric PsychiatryImpact 1.1
Dronabinol was associated with significant reduction in agitation as well as improvement in global function, sleep and food intake in patients with severe dementia.
Summary
n=40 inpatients with severe dementia; dronabinol add-on therapy showed significant improvements in all domains of the Pittsburgh Agitation Scale, in the CGI score, in sleep duration and in meal consumption; 26 adverse events, no treatment discontinuation due to adverse drug reactions.
P
PopulationInpatients with severe dementia and non-cognitive behavioral disturbances (agitation, aggressiveness), n=40
I
InterventionDronabinol (oral THC) as add-on therapy, up to 7 days, dose not explicitly specified
O
OutcomeSignificant reduction in all Pittsburgh Agitation Scale domains as well as improvement in CGI scores, sleep duration and food intake after up to 7 days; 26 adverse events, no treatment discontinuation
Confidence in the evidence
Very lowLowModerateHigh
Very low
The lowest GRADE level, the effect estimate remains uncertain.
<h4>Objective</h4>Behavioral disturbances occur frequently in demented individuals and greatly increase the burden of their care. The efficacy of pharmacotherapeutic treatment options is modest. This study was conducted to explore the efficacy and safety of dronabinol as an adjunctive treatment for agitation and aggressive behavior in severely demented patients.<h4>Methods</h4>Using a retrospective systematic chart review, we studied 40 inpatients from the McLean Hospital Geriatric Neuropsychiatry Inpatient Unit diagnosed with dementia and treated with dronabinol for behavioral or appetite disturbances. A group of geriatric psychiatrists consulted medical records to rate the patients' behaviors prior to initiation of dronabinol treatment and following up to seven days of treatment, using the Pittsburgh Agitation Scale, Clinical Global Impression, and Global Assessment of Functioning. Data on percentage of food consumed at each meal, sleep duration, and adverse events were also collected from medical records.<h4>Results</h4>The addition of dronabinol to patients' treatment regimens was associated with significant decreases in all domains of the Pittsburgh Agitation Scale. There were also significant improvements in Clinical Global Impression scores, sleep duration and percentage of meals consumed during the treatment periods. Twenty-six adverse events were recorded during dronabinol treatment, none of which led to medication discontinuation.<h4>Conclusion</h4>This report represents the largest studied cohort of dementia patients treated with dronabinol to date and confirms earlier reports that dronabinol can serve as an adjunctive treatment for neuropsychiatric symptoms in dementia. Further research, including prospective controlled trials, is needed to clarify dronabinol's role in treating noncognitive behavioral symptoms of demented individuals.