“Mr. A” was diagnosed with HD in 2008, and had been in long-term care since 2009 for social withdrawal, episodes of disorganization, and inability to function independently. He had taken risperidone 2 mg, citalopram 20 mg, and venlafaxine 150 mg daily for behavioral disturbances and mild upper-extremity chorea. In the 4 weeks preceding admission to our dementia unit, Mr. A refused all medications, was increasingly aggressive and demanding, frequently yelled at staff in a loud and hostile tone, and had hit a staff member. Between periods of aggression, he exclusively self-isolated in his room.
Mr. A was admitted on Jan 9th, 2012. His behavior and refusal of medications continued. Despite this, he developed rapport with one of our nurses and accepted intramuscular zuclopenthixol 150 mg q 2weeks, starting on Jan 14th, at which time his Cohen-Mansfield Agitation Inventory (CMAI) and Neuropsychiatric Inventory (NPI) scores were 78 and 74, respectively. Intramuscular medroxyprogesterone was started on Jan 19th, at 200 mg/week and increased to 400 mg/week over 2 weeks. Medroxyprogesterone was used because another 17-α-hydroxyprogesterone derivative, cyproterone, had been useful in treating agitation in dementia.1 His symptoms continued at equal intensity on Feb 12th, so zuclopenthixol was increased to 200 mg q 2weeks. By Feb 28th, he was much less agitated, was less self-isolated, less demanding, and accepted bathing, with a CMAI and NPI of 56 and 48, respectively. He tolerated zuclopenthixol without somnolence, motor difficulties, or other side effects. However, he developed fluid retention, which resolved with medroxyprogesterone discontinuation on Feb 21st. Four weeks after stopping medroxyprogesterone, agitation continued to be well-controlled, with a CMAI and NPI of 57 and 44, respectively, and Mr. A was discharged from hospital.