Comparison of topiramate and risperidone for the treatment of behavioral disturbances of patients with Alzheimer disease: a double-blind, randomized clinical trial

J Clin Psychopharmacol. 2010 Feb;30(1):40-3. doi: 10.1097/JCP.0b013e3181ca0c59.


Introduction: Behavioral disturbances are determining factors in handling patients with Alzheimer dementia. The current pharmacotherapy for behavioral symptoms associated with dementia is not satisfactory. Our goal was to compare a new anticonvulsant, topiramate, with a usually used medication, risperidone, for controlling behavioral disturbances of patients with Alzheimer dementia.

Method: Elderly patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of Alzheimer disease and significant behavioral disturbances were randomized to receive, for a period of 8 weeks, a flexible dose of either topiramate (25-50 mg/d) or risperidone (0.5-2 mg/d). Outcome measures were the Cohen-Mansfield Agitation Inventory, Neuropsychiatry Inventory parts 1 and 2, and the Clinical Global Impression.

Result: Forty-eight patients were randomized to treatment with either topiramate or risperidone, and 41 patients (21 of 25 in topiramate group and 20 of 23 in risperidone group) completed the trial. Both groups showed significant improvement in all outcome measures without important difference (Neuropsychiatry Inventory total score P < 0.531, Z = 0.62; Cohen-Mansfield Agitation Inventory P < 0.927, Z = 0.09; Clinical Global Impression, P < 0.654, Z = 0.48). There were no significant changes in the cognitive status of patients (assessed by Mini-Mental Status Examination) taking topiramate or risperidone during the trial.

Conclusion: Treatment with a low dose of topiramate (25-50 mg/d) demonstrated a comparable efficacy with risperidone in controlling behavioral disturbances of patients with Alzheimer dementia.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Alzheimer Disease / psychology*
  • Anticonvulsants / pharmacology
  • Anticonvulsants / therapeutic use*
  • Antipsychotic Agents / pharmacology
  • Antipsychotic Agents / therapeutic use*
  • Behavioral Symptoms / drug therapy*
  • Caregivers / psychology
  • Double-Blind Method
  • Female
  • Fructose / analogs & derivatives*
  • Fructose / pharmacology
  • Fructose / therapeutic use
  • Humans
  • Male
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Psychomotor Agitation / drug therapy
  • Psychomotor Agitation / psychology
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / psychology
  • Risperidone / pharmacology
  • Risperidone / therapeutic use*
  • Topiramate
  • Treatment Outcome


  • Anticonvulsants
  • Antipsychotic Agents
  • Topiramate
  • Fructose
  • Risperidone