Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence.
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TLDR
Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy, however, the effects are modest and further complicated by an increased risk of stroke.Abstract:
ContextNeuropsychiatric symptoms of dementia are common and associated with
poor outcomes for patients and caregivers. Although nonpharmacological interventions
should be the first line of treatment, a wide variety of pharmacological agents
are used in the management of neuropsychiatric symptoms; therefore, concise,
current, evidence-based recommendations are needed.ObjectiveTo evaluate the efficacy of pharmacological agents used in the treatment
of neuropsychiatric symptoms of dementia.Evidence AcquisitionA systematic review of English-language articles published from 1966
to July 2004 using MEDLINE, the Cochrane Database of Systematic Reviews, and
a manual search of bibliographies was conducted. Inclusion criteria were double-blind,
placebo-controlled, randomized controlled trials (RCTs) or meta-analyses of
any drug therapy for patients with dementia that included neuropsychiatric
outcomes. Trials reporting only depression outcomes were excluded. Data on
the inclusion criteria, patients, methods, results, and quality of each study
were independently abstracted. Twenty-nine articles met inclusion criteria.Evidence SynthesisFor typical antipsychotics, 2 meta-analyses and 2 RCTs were included.
Generally, no difference among specific agents was found, efficacy was small
at best, and adverse effects were common. Six RCTs with atypical antipsychotics
were included; results showed modest, statistically significant efficacy of
olanzapine and risperidone, with minimal adverse effects at lower doses. Atypical
antipsychotics are associated with an increased risk of stroke. There have
been no RCTs designed to directly compare the efficacy of typical and atypical
antipsychotics. Five trials of antidepressants were included; results showed
no efficacy for treating neuropsychiatric symptoms other than depression,
with the exception of 1 study of citalopram. For mood stabilizers, 3 RCTs
investigating valproate showed no efficacy. Two small RCTs of carbamazepine
had conflicting results. Two meta-analyses and 6 RCTs of cholinesterase inhibitors
generally showed small, although statistically significant, efficacy. Two
RCTs of memantine also had conflicting results for treatment of neuropsychiatric
symptoms.ConclusionsPharmacological therapies are not particularly effective for management
of neuropsychiatric symptoms of dementia. Of the agents reviewed, the atypical
antipsychotics risperidone and olanzapine currently have the best evidence
for efficacy. However, the effects are modest and further complicated by an
increased risk of stroke. Additional trials of cholinesterase inhibitors enrolling
patients with high levels of neuropsychiatric symptoms may be warranted.read more
Citations
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Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials.
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Caregiver burden among dementia patient caregivers: a review of the literature.
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Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials.
TL;DR: Small statistical effect sizes on symptom rating scales support the evidence for the efficacy of aripiprazole and risperidone.
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Assessment and management of behavioral and psychological symptoms of dementia
TL;DR: The paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed and non-pharmacologic approaches with the strongest evidence base involve family care giver interventions are discussed.
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Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial.
Christopher M. Callahan,Malaz Boustani,Frederick W. Unverzagt,Mary Guerriero Austrom,Teresa M. Damush,Anthony J. Perkins,Bridget A. Fultz,Siu L. Hui,Steven R. Counsell,Hugh C. Hendrie +9 more
TL;DR: In this article, the authors evaluated the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease and found that the intervention patients were more likely to receive cholinesterase inhibitors (79.8% vs 55.1%) and antidepressants (45.2% vs 27.5%).
References
More filters
Journal ArticleDOI
Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study.
Constantine G. Lyketsos,Oscar L. Lopez,Beverly N. Jones,Annette L. Fitzpatrick,John C.S. Breitner,Steven T. DeKosky +5 more
TL;DR: These are the first population-based estimates for neuropsychiatric symptoms in MCI, indicating a high prevalence associated with this condition as well.
Journal ArticleDOI
Memantine in Moderate-to-Severe Alzheimer's Disease
Barry Reisberg,Rachelle S. Doody,Albrecht Stöffler,Frederick A. Schmitt,Steven H. Ferris,Hans Jörg Möbius +5 more
TL;DR: Antiglutamatergic treatment reduced clinical deterioration in moderate-to-severe Alzheimer's disease, a phase associated with distress for patients and burden on caregivers, for which other treatments are not available.
Journal ArticleDOI
Practice parameter: Diagnosis of dementia (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology
Rachelle S. Doody,James C. Stevens,Cornelia Beck,Richard Dubinsky,Jeffrey Kaye,Lisa P. Gwyther,Richard C. Mohs,Leon J. Thal,Peter J. Whitehouse,Steven T. DeKosky,Jeffrey L. Cummings +10 more
TL;DR: Dementia criteria for dementia have improved since the 1994 practice parameter, and further research is needed to improve clinical definitions of dementia and its subtypes, as well as to determine the utility of various instruments of neuroimaging, biomarkers, and genetic testing in increasing diagnostic accuracy.
Journal ArticleDOI
Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial.
Pierre N. Tariot,Martin R. Farlow,George T. Grossberg,Stephen M. Graham,Scott D. McDonald,Ivan Gergel +5 more
TL;DR: In patients with moderate to severe AD receiving stable doses of donepezil, memantine resulted in significantly better outcomes than placebo on measures of cognition, activities of daily living, global outcome, and behavior and was well tolerated.
Journal ArticleDOI
Efficacy of rivastigmine in dementia with Lewy bodies: A randomised, double-blind, placebo-controlled international study
Ian G. McKeith,Teodoro Del Ser,PierFranco Spano,Murat Emre,Keith Wesnes,Ravi Anand,Ana Cicin-Sain,Roberto Ferrara,René Spiegel +8 more
TL;DR: Rivastigmine 6-12 mg daily produces statistically and clinically significant behavioural effects in patients with Lewy-body dementia, and seems safe and well tolerated if titrated individually.