Effects of Escitalopram on Neuropsychiatric Symptoms in Alzheimer Disease: A Secondary Analysis From the S-CitAD Study.

OBJECTIVE: Using Neuropsychiatric Inventory (NPI) data from the Escitalopram for agitation in Alzheimer disease (S-CitAD) study, the authors explored the potential impact of escitalopram on neuropsychiatric symptom domains and caregiver distress scores outside of agitation. METHODS: Caregiver-rated scores were compared from baseline to week 12 in 173 participants receiving escitalopram (5-15 mg/day) or placebo examining the presence or absence of individual neuropsychiatric symptoms, emergence of new symptoms, and median NPI domain severity scores between groups at week 12. Caregiver distress scores were additionally examined by NPI domain at baseline and at week 12 for between group changes. RESULTS: Statistical significance was seen in the depression/dysphoria domain median scores favoring the escitalopram group at week 12. Caregiver distress scores in the domains of apathy/indifference and irritability/lability favored escitalopram at week 12; however, the median NPI domain scores in these domains weren't statistically different from placebo. In evaluating the emergence of new symptoms over the 12-week period, no participants (0%) in the escitalopram group reported new hallucinations versus 5 participants (7%) in the placebo group. CONCLUSION: Escitalopram may have an impact on the severity of symptoms of depression/dysphoria in AD. No new symptoms of hallucinations in the escitalopram group throughout the 12 week trial suggest a possible direction for future research into selective serotonin reuptake inhibitors (SSRIs) and the treatment and/or delaying of psychotic symptoms in AD. As this was an exploratory analysis involving multiple comparisons, findings may be spurious.