International Psychogeriatrics

Review Article

Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

Dallas P. Seitza1 c1, Sudeep S. Gilla2, Nathan Herrmanna3a4, Sarah Brisbina1, Mark J. Rapoporta3a4, Jenna Rinesa1, Kimberley Wilsona5, Ken Le Claira1 and David K. Conna3a6

a1 Department of Psychiatry, Queen's University, Kingston, Ontario, Canada

a2 Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada

a3 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

a4 Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

a5 Canadian Coalition for Seniors’ Mental Health, Toronto, Ontario, Canada

a6 Department of Psychiatry, Baycrest Centre, Toronto, Ontario, Canada

ABSTRACT

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.

(Received February 28 2012)

(Reviewed April 15 2012)

(Revised May 10 2012)

(Accepted August 30 2012)

(Online publication October 19 2012)

Key words:

  • dementia;
  • Alzheimer;
  • long-term care;
  • pharmacological;
  • medications

Correspondence:

c1 Correspondence should be addressed to: Dr. Dallas Seitz, Geriatric Psychiatry Services, Providence Care – Mental Health Services, 752 King Street West, Kingston, Ontario, Canada, K7L 4X3. Telephone: 613-548-5567, ext: 5942; Fax: 613-540-6128. Email: seitzd@providencecare.ca

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