• Daniel Weintraub, Lea T Drye, Anton P Porsteinsson, Paul B Rosenberg, Bruce G Pollock, Devangere P Devanand, Constantine Frangakis, Zahinoor Ismail, Christopher Marano, Curtis L Meinert, Jacobo E Mintzer, Cynthia A Munro, Gregory Pelton, Peter V Rabins, Lon S Schneider, David M Shade, Jerome Yesavage, Constantine G Lyketsos, and CitAD Research Group.
• Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: daniel.weintraub@uphs.upenn.edu.
• Am J Geriatr Psychiatry. 2015 Nov 1; 23 (11): 1127-33.

ObjectiveAgitation is a common and significant problem in Alzheimer disease (AD). In the recent Citalopram for Agitation in Alzheimer's Disease (CitAD) study, citalopram was efficacious for the treatment of AD agitation. Here we examined the time course and predictors of response to treatment.MethodsResponse in CitAD was defined as a modified Alzheimer Disease Cooperative Study Clinical Global Impression of Change (CGIC) score of 1 or 2 or a Neurobehavioral Rating Scale agitation subscale (NBRS-A) score reduction ≥ 50% from baseline. "Stable early response" was defined as meeting the aforementioned criteria at both weeks 3 and 9, "late response" was response at week 9 but not at week 3, and "unstable response" was response at week 3 but not at week 9.ResultsIn the primary analyses, citalopram was superior to placebo on both the CGIC and the NBRS-A response measures. Little between-group differences were found in response rates in the first 3 weeks of the study (21% versus 19% on the CGIC). Citalopram patients were more likely than placebo patients to be a late responder (18% versus 8% on CGIC, Fisher's exact p = 0.09; 31% versus 15% on NBRS-A, Fisher's exact p = 0.02). Approximately half of citalopram responders (45%-56%) at end of study achieved response later in the study compared with 30%-44% of placebo responders.ConclusionTreatment with citalopram for agitation in AD needs to be at least 9 weeks in duration to allow sufficient time for full response. Study duration is an important factor to consider in the design of clinical trials for agitation in AD.Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

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