The findings of Dr. Porsteinsson and his colleagues support a role for citalopram in managing agitation in dementia, but "when and how to prescribe the drug so that benefits are optimized and risks minimized are not straightforward," said Dr. Gary W. Small.
The clinical relevance of the slightly worsened cognitive functioning seen with the drug is difficult to interpret, given that the MMSE has limited sensitivity in detecting such worsening in patients with dementia and that these patients’ cognitive functioning fluctuates widely depending on the time of day, minor distractions during the examination, and level of fatigue.
Most important, "minor" risks must be balanced against the disturbing symptoms of agitation, which can lead to physical harm to the patient, the caregiver, and bystanders. If citalopram indeed relieves caregiver distress, it may mitigate their risk of depression – an important treatment benefit to include in the risk equation.
Dr. Small is with the division of geriatric psychiatry at the University of California, Los Angeles. He is one of the inventors of FDDNP-PET, an investigative radioligand used to image tau neurofibrillary tangles in the brain. The patent for FDDNP-PET is held by UCLA and is licensed to TauMark. Dr. Small has a financial interest in TauMark and has served as an adviser to, or received lecture fees from, manufacturers of drugs used to treat Alzheimer’s. These remarks were taken from his editorial accompanying Dr. Porsteinsson’s report (JAMA 2014;311:677-8).
