title: Efficacy and safety of atypical antipsychotic drug treatment for dementia: a systematic review and meta-analysis.
abstract: BACKGROUND
  A wide variety of atypical antipsychotic drugs (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone and clozapine) are widely used in the management of neuropsychiatric symptoms, which are commonly seen in dementia, but results from randomised controlled trials (RCTs) on the efficacy and safety of these agents are conflicting. We aimed to quantify the efficacy and safety of atypical antipsychotic drugs on neuropsychiatric symptoms in dementia patients.
  
  
  METHODS
  PubMed, EMBASE, the Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews for reports published before August 2014 were searched for eligible randomized controlled trials of atypical antipsychotic drugs therapy in patients with psychotic symptoms of dementia. Two reviewers independently assessed the quality of the trials and extracted information.
  
  
  RESULTS
  Overall, 23 relevant RCTs with 5,819 participants were identified. This meta-analysis demonstrated a significant efficacy of atypical antipsychotics on psychiatric symptoms and cognitive functions compared to placebo. In the meta-analysis, the weighted mean differences (WMDs) in change scores for psychiatric symptoms were in favor of aripiprazole (-4.4, 95% confidence interval (CI) - 7.04 to -1.77) and risperidone (-1.48, 95% CI -2.35 to -0.61) compared to placebo. In cognitive effects, WMDs in change scores for the Clinical Global Impression-Change (CGI-C) were in favor of aripiprazole, risperidone, olanzapine and quetiapine which ranged from a -0.30 points mean difference (95% CI:-0.59 to -0.01) in the aripiprazole trials to -0.43 (95% CI:-0.62 to -0.25) in the risperidone group. Patients receiving atypical antipsychotics showed no difference in risk for injuries or falls (P > 0.05), significantly higher risks (P < 0.05) for somnolence, urinary tract infection, edema and abnormal gait. However, there was no significant evidence for death reported.
  
  
  CONCLUSIONS
  Aripiprazole and risperidone are able to improve psychiatric symptoms and slow decline in cognition function at average 12 weeks in patients with neuropsychiatric symptoms of dementia. However, high adverse events may offset the efficacy of atypical antipsychotics in dementia.
authors.affiliation: College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, 266000 China.
authors.forename: Lin
authors.initials: L
authors.lastname: Tan
authors.affiliation: College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, 266000 China ; Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China ; Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, 210000 China.
authors.forename: Lan
authors.initials: L
authors.lastname: Tan
authors.affiliation: Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, 210000 China.
authors.forename: Hui-Fu
authors.initials: HF
authors.lastname: Wang
authors.affiliation: Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China.
authors.forename: Chen-Chen
authors.initials: CC
authors.lastname: Tan
authors.affiliation: College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, 266000 China.
authors.forename: Meng-Shan
authors.initials: MS
authors.lastname: Tan
authors.affiliation: Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China.
authors.forename: Xiang-Fei
authors.initials: XF
authors.lastname: Meng
authors.affiliation: Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China.
authors.forename: Chong
authors.initials: C
authors.lastname: Wang
authors.affiliation: College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, 266000 China ; Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071 China ; Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, 210000 China.
authors.forename: Jin-Tai
authors.initials: JT
authors.lastname: Yu