Gregory GoldenbergNew York Presbyterian Brooklyn Methodist Hospital, USA
Title: Low dose Gabapentin for Behavioral Symptoms in Dementia with Lewy Bodies. Case series, brief review of pharmacology and a hypothesis
Aim: To evaluate low dose gabapentin in treatment of disruptive behavioral symptoms in patients with moderate – severe dementia with Lewy bodies.
Findings: Improvement in symptoms seen by clinician and caregivers supported by changes on respective scales.
Message: Preliminary positive evidence suggesting that low dose gabapentin can be used for treatment of disruptive symptoms in patients affected by dementia with Lewy bodies. Purpose: To evaluate low dose gabapentin (GBP) for treatment of disruptive behavioral symptoms in patients with moderate – severe dementia with Lewy bodies. Methods. A case series in a community setting. Eleven (10 females) community dwelling elderly patients (79-97 years; 85.2 SD 6.4) with moderate (5 patients) and severe (6 patients) probable Dementia with Lewy bodies (DLB) treated with low daily dose of GBP (200 -600 mg; 341 SD 153) for vocal disruption, aggression, psychomotor hyperactivity and disturbed sleep. Symptoms rated by the clinician on Cohen-Mansfeld Agitation Inventory (CMAI) and on de novo designed VAPS (acronym of symptoms) scale. Caregivers rated treatment on Clinical Global Impression of Change (CGI-C) scale. GBP was used for 12 and more weeks as monotherapy (7 patients) and with other pharmaceuticals (4 patients) and was well tolerated. Results. Improvement in behavioral symptoms. The scores declined on CMAI scale from 49.2 (SD 26.5) to 26.4 (SD 14.7) or by 22.8 (CI =14.2 - 31.5) and on VAPS scale from 8.2 (SD 1.3) to 1.7 (SD 0.8) or by 6.45 (CI=4 - 8). Caregivers rated improvement as moderate in 3 patients (score of 2) and substantial in 8 patients (score of 1), mean CGI-C score of 1.3 (SD 0.5).
Conclusions: This uncontrolled open label study provides preliminary evidence suggesting that low dose GBP can be used for treatment of disruptive/VAPS symptoms in patients affected by DLB. The authors hypothesize that change in glutamate / gamma aminobutyric acid balance is linked to the effect of GBP on disruptive behaviors and favor low vs high dose of GBP in patients with dementia. Key words: Gabapentin, dementia with Lewy bodies, behavioral rating scale, brain neurotransmitter balance.