Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review.
BACKGROUND
Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC.


METHODS
We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality.


RESULTS
A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications.


CONCLUSIONS
We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. seitzd@providencecare.ca
Dallas P
DP
Seitz
Sudeep S
SS
Gill
Nathan
N
Herrmann
Sarah
S
Brisbin
Mark J
MJ
Rapoport
Jenna
J
Rines
Kimberley
K
Wilson
Ken
K
Le Clair
David K
DK
Conn
D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D003704:Dementia / Q000150:complications / Q000188:drug therapy*; D003943:Diagnostic Techniques, Neurological; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011569:Psychiatric Status Rating Scales; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors