An Overview of Systematic Reviews of Pharmacological and Non-pharmacological Interventions for the Treatment of Behavioral and Psychological Symptoms of Dementia
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; Music Listening; Music Medicine; Neurocognitive Disorders; Psychological Outcomes; Recorded Music Listening; Wellness and Well-Being
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
Quantitative Methods; Systematic Review
Psychiatric and Mental Health
Dyer, S. M., Harrison, S. L., Laver, K., Whitehead, C., & Crotty, M. (2018). An Overview of Systematic Reviews of Pharmacological and Non-pharmacological Interventions for the Treatment of Behavioral and Psychological Symptoms of Dementia. International Psychogeriatrics, 30 (3), 295-309. Retrieved from https://remix.berklee.edu/mhi-music-mental-health/109