Question: In older adults with dementia, are sodium valproate and other anticonvulsants more effective than antipsychotics, for reducing agitation and excessive activity or 'drive'?

Answer:

No definite clinical implications can be made from the available evidence. It does not appear that any studies have directly compared sodium valproate or other anticonvulsants with antipsychotics. Most of the studies evaluated have compared anticonvulsants with placebo.

There is a common theme in the literature - that there is limited evidence on the use of anticonvulsants, both in terms of number of studies, and in terms of the methodological quality of the available studies. In addition, many of the treatments were associated with problematic side effects, prompting some authors to suggest that they should be used with caution. There is also a lack of evidence specifically on valproate, and review authors have suggested that this treatment may not be recommended for the first-line treatment of demented patients with agitation.

All review authors suggested that more research is needed in this area, and most mentioned the need for the further development of safe and effective pharmacological and non-pharmacological interventions for patients with dementia.

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