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Antipsychotics can be withdrawn from many older people with dementia, though caution is needed for people with more severe neuropsychiatric symptoms

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Question

Question: Is the withdrawal of antipsychotic medication in older people with dementia and neuropsychiatric symptoms (NPS) feasible, safe and effective?

Outcomes: Primary outcomes: success of withdrawal strategy, defined as remaining in the trial off antipsychotic medication (no dropout due to worsening NPS or relapse to antipsychotic use during the trial); behavioural and psychological symptoms, especially agitation, aggression and psychotic symptoms; withdrawal symptoms (including autonomic and behavioural symptoms) and adverse effects of antipsychotics. Secondary outcomes: cognitive function; quality of life (participants and carers); use of physical restraint; and mortality.

Methods

Design: Systematic review and meta-analysis.

Data sources: The Specialised Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) and ALOIS, which is maintained by the Dementia Group and includes studies identified from CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, clinical trials registries and grey literature sources; search dates February 2009 to November 2012.

Study selection and analysis: Inclusions: Randomised placebo-controlled trials comparing an antipsychotic withdrawal strategy (either abrupt or tapered) with medication continuation, in older people (≥65 years) with dementia under primary care or …

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