Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review.
OBJECTIVE
To review the role of oral atypical antipsychotic drugs in the management of the behavioural and psychological symptoms of dementia (BPSD).


METHODS
Medline, Embase, and the Cochrane Library. Reference lists were reviewed and experts were contacted to identify additional trials.


METHODS
Double blind randomised controlled trials that evaluated the four oral atypical antipsychotic therapies for BPSD.


METHODS
Two reviewers assessed trial validity independently.


METHODS
Demographics of patients, study duration, dose of antipsychotic, primary end points, adverse events.


RESULTS
77 abstracts were reviewed. Five randomised trials (1570 patients) evaluating risperidone and olanzapine were identified. The quality of trials was generally good. Most participants were in an institution (> 96%), elderly (weighted mean 82.3 years), and had Alzheimer's disease (76.3%). Trials lasted 6-12 weeks. Treatment with atypical antipsychotic drugs was superior to placebo for the primary end point in three of the five trials. Two trials comparing risperidone with haloperidol did not find any differences in the primary measures of efficacy. Adverse events were common and included extrapyramidal symptoms, somnolence, and abnormal gait.


CONCLUSIONS
Although atypical antipsychotic drugs are being used with increasing frequency, few randomised trials have evaluated their use for BPSD. Limited evidence supports the perception of improved efficacy and adverse event profiles compared with typical antipsychotic drugs.
Lee
Philip E
PE
Rotman Research Institute, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1. pelee@providencehealth.bc.ca
Gill
Sudeep S
SS
Freedman
Morris
M
Bronskill
Susan E
SE
Hillmer
Michael P
MP
Rochon
Paula A
PA
D000284:Administration, Oral; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001526:Behavioral Symptoms / Q000188:drug therapy*; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D014150:Antipsychotic Agents