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Comparative efficacy and safety of therapy for the behavioral and psychological symptoms of dementia: a systemic review and Bayesian network meta-analysis

  • Boru Jin
  • Huayan LiuEmail author
Review
  • 211 Downloads

Abstract

Objective

To assess the comparative efficacy and safety of both pharmacological and non-pharmacological therapies for the behavioral and psychological symptoms of dementia, using direct and indirect evidence from randomized data.

Method

A systematic review and Bayesian network meta-analysis was conducted on only randomized controlled trials (RCTs) of all the available interventions for BPSD. RCTs were selected from Pubmed, EMBASE, the Cochrane library, and CINAHL. The efficacy outcomes were Neuropsychiatric Inventory (NPI) and Cohen–Mansfield Agitation Inventory (CMAI). The outcomes of safety were total adverse events (AEs), diarrhea, dizziness, headache, falls, nausea, vomiting, and cerebrovascular diseases.

Result

146 RCTs comprising 44,873 patients with BPSD were included in this study. On NPI, aripiprazole (MD − 3.65, 95% credible interval (CrI) = − 6.92 to − 0.42), escitalopram (MD − 6.79, 95% CrI − 12.91 to − 0.60), donepezil (MD − 1.45, 95% CrI − 2.70 to − 0.20), galantamine (MD − 1.80, 95% CrI − 3.29 to − 0.32), memantine (MD − 2.14, 95% CrI − 3.46 to − 0.78), and risperidone (MD − 3.20, 95% CrI − 6.08 to − 0.31) were superior to placebo. On CMAI, aripiprazole (MD − 4.00, 95% CrI − 7.39 to − 0.54) and risperidone (MD − 2.58, 95% CrI − 5.20 to − 0.6) showed superiority to placebo. On the risk of total AEs, donepezil (OR 1.27, 95% CrI 1.07–1.50), galantamine (OR 1.91, 95% CrI 1.58–2.36), risperidone (OR 1.47, 95% CrI 1.13–1.97), and rivastigmine (OR 2.02, 95% CrI 1.53–2.70) owned higher risk than placebo.

Conclusion

Pharmacological therapies should be the first choice for BPSD. Aripiprazole, haloperidol, quetiapine, and risperidone of antipsychotics showed the significant efficacy, while memantine, galantine, and donepezil may provide the modest effectiveness. The safety of all was thought to be acceptable.

Keywords

Dementia Behavioral and psychological symptoms of dementia Pharmacological therapy Non-pharmacological therapy Systematic review Network meta-analysis 

Notes

Acknowledgements

During the process of data extraction, Yunting Xu intervened as a third reviewer to call the final determination when there still existed controversy after discussed by the two authors. We thank Yunting Xu for her work in this study.

Funding

National Natural Science Foundation of Liaoning province. Funding number: 20170541036.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no competing interest.

Supplementary material

415_2019_9200_MOESM1_ESM.docx (47 kb)
Appendix 2 Figure 1. League tables of efficacy and safety of included therapies for behavioral and psychological symptoms of dementia. Drugs are reported in Alphabet order. The estimates are located at the intersection of the column-defining treatment and the row-defining treatment. When the data of mean differences (MD) with 95% credible interval (CrI) displayed above blue grid is positive, the efficacy of column-defining treatment is identified more beneficial than the row-defining treatment, and vice versa. When the data odds ratios with 95% CrI displayed above blue grid is smaller than 1.0 the safety of column-defining treatment is identified more tolerate comparing with the row-defining treatment. Significant results are bolded to underscore. Aripiprazole; ARO = Aromatherapy; CIT = Escitalopram; CST = Cognitive stimulated training; DIS = Discontinuation of antipsychotics; DON = Donepezil; EXE = Exercise; GAL = Galantamine; HAL = haloperidol; LIG = Light therapy; MEM = methylphenidate; MET = Methylphenidate; OLA = Olanzapine; PLA = Placebo; QUE = Quetiapine; REM = Reminiscence therapy; RIS = Risperidone; RIV = Rivastigmine; RIV P = Rivastigmine patch; SER = Sertraline; TRA = Trazodone; VAL = valproate; YOK = Yokukansan (DOCX 46 KB)
415_2019_9200_MOESM2_ESM.docx (17 kb)
Appendix 3 Figure 2. Rank possibility of therapies for behavioral and psychological symptoms of dementia. The ranks are from the least efficacy to the most and from the highest risk of adverse events to the lowest. (A) NPI = Neuropsychiatric Inventory; (B) Cohen–Mansfield Agitation Inventory (CMAI); (C) Total adverse events; (D) Diarrhea; (E) Dizziness; (F) Falls; (G) Headache; (H) Nausea; (I) Vomiting. ARO = Aromatherapy; CIT = Escitalopram; CST = Cognitive stimulated training; DIS = Discontinuation of antipsychotics; DON = Donepezil; EXE = Exercise; GAL = Galantamine; HAL = haloperidol; LIG = Light therapy; MEM = methylphenidate; MET = Methylphenidate; OLA = Olanzapine; PLA = Placebo; QUE = Quetiapine; REM = Reminiscence therapy; RIS = Risperidone; RIV = Rivastigmine; RIV P = Rivastigmine patch; SER = Sertraline; TRA = Trazodone; VAL = valproate; YOK = Yokukansan (DOCX 16 KB)
415_2019_9200_MOESM3_ESM.docx (192 kb)
Appendix 1. Baseline characteristics of included studies. NPI = Neuropsychiatric Inventory; Cohen–Mansfield Agitation Inventory (CMAI) (DOCX 192 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurology, First Affiliated HospitalChina Medical UniversityShenyangPeople’s Republic of China

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