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Review: pharmacotherapy provides minimal improvements in the neuropsychiatric symptoms of dementia

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Q How effective are pharmacological treatments for the neuropsychiatric symptoms of dementia?


Embedded ImageDesign:

Systematic review.

Embedded ImageData sources:

MEDLINE (1966 to July 2004), Cochrane Database of Systematic Reviews, plus hand search of reference lists.

Embedded ImageStudy 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.

Embedded ImageOutcomes:

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 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 …

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