Dementia: no single best option for behavioral, psychological symptoms

  • Yunusa I & al.
  • JAMA Netw Open
  • 1 Mar 2019

  • International Clinical Digest
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Takeaway

  • A meta-analysis of atypical antipsychotics (AAPs) found no significant difference in efficacy and safety among aripiprazole, olanzapine, quetiapine, and risperidone for the treatment of behavioral and psychological symptoms of dementia (BPSD).

Why this matters

  • There may not be a single most effective AAP for the treatment of BPSD, as available AAPs have significant safety risks while offering only minimal benefits compared with placebo.

Study design

  • This network meta-analysis evaluated 17 randomized clinical trials involving 5373 patients (age, ≥65 years) with BPSD.
  • Funding: None disclosed.

Key results

  • Compared with placebo, aripiprazole was associated with improvement in:
    • neuropsychiatric inventory (NPI; standardized mean difference [SMD], −0.17; 95% CI, −0.31 to −0.02),
    • Brief Psychiatric Rating Scale (BPRS; SMD, −0.20; 95% CI, −0.35 to −0.05), and
    • Cohen-Mansfield Agitation Inventory (CMAI; SMD, −0.30; 95% CI, −0.55 to −0.05).
  • Compared with placebo, quetiapine was associated with improvement in BPRS (SMD, −0.24; 95% CI, −0.46 to −0.01) and risperidone with improvement in CMAI (SMD, −0.26; 95% CI, −0.37 to −0.15).
  • No statistically significant difference observed between AAPs for NPI, BPRS, or CMAI.
  • Risk for death and cerebrovascular adverse events was not significantly different among any of the included AAPs.

Limitations

  • Limited number of studies included.

Coauthored with Antara Ghosh, PhD