title: Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms.
abstract: BACKGROUND
  Within the treatment of dementia, management of behavioural and psychological symptoms (BPSD) is a complex component.
  
  
  OBJECTIVE
  We wanted to offer a pragmatic synthesis of existing specific practice recommendations for managing BPSD, based on agreement among systematically appraised dementia guidelines.
  
  
  METHODS
  We conducted a systematic search in MEDLINE and guideline organisation databases, supplemented by a hand search of web sites.
  
  
  METHODS
  Fifteen retrieved guidelines were eligible for quality appraisal by the Appraisal of Guidelines Research and Evaluation instrument (AGREE), performed by 2 independent reviewers.
  
  
  METHODS
  From the 5 included guidelines, 18 specific practice recommendations for BPSD were extracted and compared for their level of evidence and strength.
  
  
  RESULTS
  No agreement was found among dementia guidelines for the majority of specific practice recommendations with regard to non-pharmacological interventions, although these were recommended as first-line treatment. Pharmacological specific practice recommendations were proposed as second-line treatment, with agreement for the use of a selection of antipsychotics based on strong supporting evidence, but with guidance for timely discontinuation.
  
  
  CONCLUSIONS
  The appraisal of the level of agreement between guidelines for each specific practice recommendation was complicated by variation in grading systems, and was performed with criteria developed a posteriori.
  
  
  CONCLUSIONS
  Despite the limited number of recommendations for which agreement was found, guidelines did agree on careful antipsychotic use for BPSD. Adverse events might outweigh the supporting evidence of efficacy, weakening the recommendation. More pivotal trials on the effectiveness of non-pharmacological interventions, as well as guidelines specifically focusing on BPSD, are needed.
authors.affiliation: Ghent University, Heymans Institute of Pharmacology, Belgium. majda.azermai@ugent.be
authors.forename: Majda
authors.initials: M
authors.lastname: Azermai
authors.forename: Mirko
authors.initials: M
authors.lastname: Petrovic
authors.forename: Monique M
authors.initials: MM
authors.lastname: Elseviers
authors.forename: Jolyce
authors.initials: J
authors.lastname: Bourgeois
authors.forename: Luc M
authors.initials: LM
authors.lastname: Van Bortel
authors.forename: Robert H
authors.initials: RH
authors.lastname: Vander Stichele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001526:Behavioral Symptoms / Q000209:etiology / Q000628:therapy*; D002985:Clinical Protocols / Q000592:standards; D003704:Dementia / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005852:Geriatric Psychiatry / Q000379:methods / Q000592:standards / Q000639:trends; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D019965:Neurocognitive Disorders / Q000209:etiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards / Q000639:trends; D017410:Practice Guidelines as Topic / Q000592:standards*