title: The effect of treatment with selective serotonin reuptake inhibitors in comparison to placebo in the progression of dementia: a systematic review and meta-analysis.
abstract: selective serotonin reuptake inhibitors (SSRIs) may affect the neurodegenerative process of dementia, enhancing cognition. This systematic review aims to determine whether SSRIs influence cognitive performance, mood and function in people with any type of dementia.
  
  
  
  randomised placebo-controlled studies of SSRIs in people with dementia, which recorded cognitive outcomes, were identified in ALOIS (ALzheimer's and cOgnitive Improvement Studies register) in April 2013 and updated in January 2015. Data were extracted on cognition, agitation, mood, activities of daily living (ADLs) and adverse events. End of treatment statistics were calculated.
  
  
  
  twelve studies met inclusion criteria (1,174 participants), of which seven studies (710 participants) provided data for meta-analysis on cognition. There was no difference in MMSE score at end of treatment; mean difference (MD) was 0.28 (95% CI -0.83 to 1.39) (six studies, 470 participants). For change in MMSE scores, there was a small improvement; MD was 0.53 (95%CI -0.07 to 1.14) (three studies, 352 participants). The remaining studies showed no improvement in cognition. There was no statistically significant benefit of SSRIs on mood (four studies, 317 participants); standard mean difference (SMD) -0.10 (95% CI -0.39 to 0.2), agitation (three studies, 189 participants); SMD -0.01(95% CI -0.86 to 0.83), or ADLs at end of treatment (four studies, 336 participants); SMD -0.15(95% CI -0.45 to 0.15). There was no difference in mortality between the two groups. Study quality was mixed with concerns over incomplete data.
  
  
  
  a small number of relatively low-powered studies showed no benefit or harm from SSRIs in terms of cognition, mood, agitation or ADLs. Large, methodologically robust studies are needed.
authors.affiliation: Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Jones
authors.affiliation: Ninewells Hospital, Dundee, UK.
authors.forename: Alka
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Geriatric Medicine, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Shenkin
authors.affiliation: Department of Geriatric Medicine, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Mead
mesh_terms: D000203:Activities of Daily Living; D000339:Affect / Q000187:drug effects; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003071:Cognition / Q000187:drug effects*; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration; D018696:Neuroprotective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016017:Odds Ratio; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018696:Neuroprotective Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: SSRI; dementia; older people; placebo; systematic review