Pharmacological Management of Neuropsychiatric Symptoms of Dementia
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Geriatric Disorders (M Sajatovic and A Aftab, Section Editors)
Pharmacological Management of Neuropsychiatric Symptoms of Dementia Lauren B. Gerlach, DO, MS1,2,* Helen C. Kales, MD3 Address 1 Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA *,2 Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA Email: [email protected] 3 Department of Psychiatry, University of California, Davis, CA, USA
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Geriatric Disorders Keywords Neuropsychiatric symptoms I Pharmacologic treatment I Dementia
Abstract Purpose Neuropsychiatric symptoms are universal across all stages and types of dementia and can cause significant challenges for patients and caregivers. While there are currently no approved medications for treatment of neuropsychiatric symptoms of dementia, a variety of psychotropic medications such as antipsychotics, benzodiazepines, anticonvulsants, and antidepressants are used off-label to treat these symptoms. This systematic review evaluated the available evidence for effectiveness and tolerability of pharmacologic treatments in addressing behavioral disturbances in dementia. Recent findings Inclusion criteria were placebo-controlled, randomized controlled clinical trials (RCTs) or meta-analyses; a total of 38 studies and 3 meta-analyses representing an additional 27 RCTs met the inclusion criteria. Of the medication classes evaluated, atypical antipsychotics had the greatest available evidence for use; however, the treatment effect size was modest. Nine trials of antidepressants were included; 3 trials supported use in dementia. Eight trials of anticonvulsants were included; only one showed benefit. For benzodiazepines, 2 RCTs were included; only one trial of lorazepam showed improvement. Six trials of melatonin agonists were included; none showed efficacy outside of improved sleep measures. Evidence for effectiveness of pimavanserin and dextromethorphan-quinidine was limited to one study each, both of which showed benefit. Summary Despite the widespread off-label use of psychotropic medications for treatment of neuropsychiatric symptoms in dementia, there are relatively few RCTs to
Geriatric Disorders (M Sajatovic and A Aftab, Section Editors) evaluate their use with treatment effect sizes absent or modest for most medication classes. Of the medication classes reviewed, atypical antipsychotics have the best evidence for effectiveness; however, the overall magnitude of treatment effect is modest and must be balanced with risk of serious adverse events including death.
Introduction Although memory impairment is typically thought of as the cardinal feature of dementia, neuropsychiatric or behavioral and psychological symptoms of dementia are nearly universal across all types and stages of dementia. Longitudinal studies of patients with dementia demonstrate that 97% of patients will develop one or more behavioral disturbances during the course of the
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