Comparative efficacy and safety of therapy for the behavioral and psychological symptoms of dementia: a systemic review and Bayesian network meta-analysis
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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.
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.
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.
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.
KeywordsDementia Behavioral and psychological symptoms of dementia Pharmacological therapy Non-pharmacological therapy Systematic review Network meta-analysis
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.
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.
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