Therapeutics
Review: pharmacotherapy provides minimal improvements in the neuropsychiatric symptoms of dementia
Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA 2005;293:596–608.
Q How effective are pharmacological treatments for the neuropsychiatric symptoms of dementia?
Key Words: pharmacotherapy • neuropsychiatric symptoms • dementia
| The first 150 words of the full text of this article appear below. |
Design:
Systematic review.
Data sources:
MEDLINE (1966 to July 2004), Cochrane Database of Systematic Reviews, plus hand search of reference lists.
Study selection and analysis:
The review included placebo controlled, double blind randomised controlled trials (RCTs) of drug therapy for the neuropsychiatric symptoms of dementia, and meta-analyses of such RCTs. Studies of drugs not available in the US or no longer in clinical use and studies of depressive symptoms alone were excluded.
Outcomes:
Neuropsychiatric symptoms.
Atypical antipsychotics: six RCTs, all of risperidone or olanzapine, met inclusion criteria. Four RCTs (1380 people) found that antipsychotic treatment improved neuropsychiatric symptoms compared with placebo (see http://www.ebmentalhealth.com/supplemental for table). However, improvements were often small, and risperidone and olanzapine have been reported to increase cerebrovascular events in people with dementia. Typical antipsychotics: two meta-analyses met inclusion criteria. One meta-analysis (seven RCTs; 252 people) found that typical antipsychotics reduced neuropsychiatric symptoms more than placebo (standardised effect
Department of Psychiatry, University of Pittsburgh School of Medicine,
USA
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