Effects of citalopram on neuropsychiatric symptoms in Alzheimer's dementia: Evidence from the CitAD study

Objective: Citalopram has been shown to improve agitation in patients with Alzheimer's disease. The authors evaluated whether other neuropsychiatric symptoms improve with citalopram treatment compared with placebo. Method: In this planned secondary analysis of the Citalopram for Agitation in Alzheimer's Disease study, the authors evaluated the effect of citalopram on the 12 neuropsychiatric symptomdomainsassessedbytheNeuropsychiatricInventory (NPI). They compared caregiver-reported NPI scores at week 9 in patients receiving citalopram(30mg/day) or placebowith regard to both the presence or absence of individual neuropsychiatric symptoms and individualdomain scores (reflecting severity) in participants who had symptoms at week 9. Results: At week 9, participants treated with citalopram were significantly less likely to be reported as showing delusions (odds ratio=0.40), anxiety (odds ratio=0.43), and irritability/ lability (odds ratio=0.38). A comparison of median scores of participants with symptoms present at week 9 showed significant differences favoring citalopram for hallucinations and favoring placebo for sleep/nighttime behavior disorders. Conclusions: While dosage constraints must be considered because of citalopram's adverse effect profile, this agent's overall therapeutic effects in patients with Alzheimer's disease and agitation, in addition to efficacy for agitation/ aggression, included reductions in the frequency of irritability, anxiety, and delusions; among patients who had these symptoms at week 9, they included a reduction in the severity of hallucinations but an increase in the severity of sleep/ nighttime behavior disorders.