An Overview of Systematic Reviews of Pharmacological and Non-pharmacological Interventions for the Treatment of Behavioral and Psychological Symptoms of Dementia

Journal

International Psychogeriatrics

Year

2018

Volume

30

Issue

3

First Page

295

Last Page

309

Abstract

ABSTRACTBackground:This systematic overview reports findings from systematic reviews of randomized controlled trials of pharmacological and non-pharmacological interventions for behavioural and psychological symptoms of dementia (BPSD). METHODS: The Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE, and PsycINFO were searched to September 2015. RESULTS: Fifteen systematic reviews of eighteen different interventions were included. A significant improvement in BPSD was seen with: functional analysis-based interventions (GRADE quality of evidence moderate; standardized mean difference (SMD) -0.10, 95%CI -0.20 to 0.00), music therapy (low; SMD -0.49, 95%CI -0.82 to -0.17), analgesics (low; SMD -0.24, 95%CI -0.47 to -0.01), donepezil (high; SMD -0.15 95% CI -0.29 to -0.01), galantamine (high; SMD -0.15, 95%CI -0.28 to -0.03), and antipsychotics (high; SMD -0.13, 95%CI -0.21 to -0.06). The estimate of effect size for most interventions was small. CONCLUSIONS: Although some pharmacological interventions had a slightly larger effect size, current evidence suggests functional analysis-based interventions should be used as first line management of BPSD whenever possible due to the lack of associated adverse events. Music therapy may also be beneficial, but further research is required as the quality of evidence to support its use is low. Cholinesterase inhibitors donepezil and galantamine should be trialled for the management of BPSD where non-pharmacological treatments have failed. Low-quality evidence suggests that assessment of pain should be conducted and a stepped analgesic approach trialled when appropriate. Antipsychotics have proven effectiveness but should be avoided where possible due to the high risk of serious adverse events and availability of safer alternatives.

Music and Health Institute Terms

Analgesic Intake; Elderly; Medication Use; Mental Health; Music Listening; Music Medicine; Neurodegenerative Disorders; Psychological Outcomes; Recorded Music Listening; Wellness and Well-Being

Indexed Terms

Antipsychotic Agents; Behavioral Symptoms; Cholinesterase Inhibitors; Complementary Therapies; Dementia; Mental Disorders; Randomized Controlled Trials as Topic; antipsychotics; behavioral symptoms; cholinesterase inhibitors; complementary therapies; dementia; systematic review

Study Type

Quantitative Methods; Systematic Review

Disciplines

Psychiatric and Mental Health

PubMed ID

29143695

Document Type

Article

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