Naltrexone Effects in Patients With Dementia
To the Editor: In their recent articles published in the Journal, Blazer and Wu (1) and Mathews and Oslin (2) have drawn attention to alcohol use among the elderly. Furthermore, a recent Treatment in Psychiatry article, by Johnson (3), highlighted pharmacologic interventions for alcoholism, where naltrexone was suggested in two out of three cases, including for a 66-year-old patient. To add to the discussion of naltrexone use in the elderly, three cases are presented suggesting potential benefits of naltrexone for the treatment of alcoholism complicating dementia.
“Mr. S” was an 84-year-old man with long-standing bipolar I disorder and alcoholism. He had developed dementia as a result of Alzheimer's disease. His persistent alcoholism included consumption of up to one-fifth of whiskey daily, which led to bizarre and dangerous behaviors. He began naltrexone (50 mg daily), which resulted in reduced interest in alcohol within the first week. This improvement was sustained even after treatment was discontinued 6 months later.
“Ms. A” was an 86-year-old woman with frontotemporal dementia who repeatedly drank scotch to intoxication, resulting in frequent falls. Bottles of liquor were stashed throughout her house, and she became acutely agitated if she was prevented from buying more. While receiving treatment with naltrexone (50 mg daily), the forcefulness of her alcohol-seeking behavior abated, and after 3 weeks she discontinued drinking altogether. Naltrexone was continued for a full year, with continued sobriety.
“Mr. C” was a 68-year-old man with Wernicke-Korsakoff syndrome. He was able to live independently with a supportive landlord, but placement in a secure facility was considered after several hospitalizations resulted from his drinking to unconsciousness. While receiving treatment with naltrexone (50 mg), he discontinued frequenting local bars and was able to continue living in his familiar neighborhood.
Published data on the use of naltrexone in the elderly is not available, but it is of note that alcohol abuse ended promptly in these three cases. Clinical benefit was significant given that these patients continued to live in their communities with a reduction in caregiver stress and reduced harmful events such as falls. The beneficial response observed in these cases is unlikely the result of a placebo response, and the prompt reduction in alcohol craving probably represents a true neuropharmacologic effect of reducing alcohol-related euphoria and undermining alcohol-seeking behavior. While progression of dementia may have contributed to reduced addictive behaviors, the prompt reduction in drinking does suggest that anticraving medications may have a role for elderly patients.
1. : Epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health. Am J Psychiatry 2009; 166:1162–1169Link, Google Scholar
2. : Alcohol misuse among the elderly: an opportunity for prevention. Am J Psychiatry 2009; 166:1093–1095Link, Google Scholar
3. : Medication treatment of different types of alcoholism. Am J Psychiatry 2010; 167:630–639Link, Google Scholar
