Key Points
Question
Which atypical antipsychotic is most beneficial and safe for the treatment of behavioral and psychological symptoms of dementia?
Findings
In this network meta-analysis of 17 studies (5373 patients), no significant differences were found across measures of effectiveness and safety among aripiprazole, olanzapine, quetiapine, and risperidone, although differences were found for some of these drugs and outcomes compared with placebo. No trials were found for other atypical antipsychotics.
Meaning
Insufficient evidence exists on which atypical antipsychotic is both safest and most beneficial across several measures for people with dementia, and this study suggests that a single most effective and safe treatment option may not exist.
Background: Alzheimer’s disease (AD) is the 6th leading cause of death in the United States and has no cure or progression prevention. The Cognitive Reserve (CR) theory poses that constant brain activity earlier in life later helps to deter pathological changes in the brain, delaying the onset of disease symptoms. Objective: To determine the reliability and validity of the Cognitive Reserve Index questionnaire (CRIq) in AD patients. Methods: Primary data collection was done using the CRIq to quantify CR in 90 participants. Correlations and multivariable linear regressions were used to assess reliability and validity. Results: Reliability was tested in 34 participants. A Pearson correlation coefficient of 0.89 (p < 0.001) indicated a strong positive correlation. Validity was tested in 33 participants. A Pearson correlation coefficient of 0.30 (p = 0.10) indicated an insignificant weak positive correlation. Conclusion: The CRIq was found reliable. Gaining a better understanding of how CR tools can be used in various cognitive populations will help with the establishment of a research tool that is universally accepted as a true CR measure.
the Cumulative Ranking Curve (SUCRA), placebo was ranked as the best treatment approach (81.5%); followed by risperidone (57.8%); followed by aripiprazole (40.3%) followed by quetiapine (37.4%); then olanzapine (33.0%). ConClusions: According to the network meta-analysis, when compared with each other and when compared to placebo, there is no statistically significantly risk of death from the use of atypical antipsychotics. Cumulative ranking probabilities suggests that risperidone is the safest treatment approach after placebo.
Background
The incidence and prevalence of Alzheimer’s disease (AD) continues to rise in the growing elderly population putting public health at increased economic, healthcare, and caregiving burdens. The effects of AD pathology on the brain are irreversible, making it hard to determine effective treatment after symptom onset. Primary prevention has been proven to reduce the risk of developing AD later in life. Past research found that cognitive reserve (CR), an individual’s ability to cope with brain changes, impacts AD risk. The buildup of CR over a life span has shown positive cognitive implications. However, the influence that CR has on the rate of AD progression remains to be explored. This study used a survey tool that accounts for all CR proxies to explore this gap.
Method
To quantify CR in the study population of 90 AD participants, the Cognitive Reserve Index questionnaire was used. The Clinical Dementia Rating scale was utilized to stage AD progression. One‐way ANOVA and Independent Samples T‐tests were used to test for differences between the mean CR scores of dementia groups. One‐way ANOVA was also used to test for differences between CR level groups and mean number of days it took to transition from one dementia stage to the next. Multivariable linear regression was utilized to determine the unit change in time associated with an increase in CR score.
Result
There was not a significant difference in mean CR score by dementia group (F = 1.96, p = 0.15). After collapsing the moderate and severe dementia groups to compare to the mild dementia group, there was a significant difference in mean CR score (mild mean (SD) = 131(15.0), moderate/severe mean (SD) = 123(20.6), p = 0.05). After controlling for physical activity, for every unit increase in CR score, the number of days for transitioning from mild to severe dementia increased by 34 days (β = 33.94, 95% CI: 8.07, 59.81, p = 0.01).
Conclusion
Higher CR was associated with slower AD progression. This indicates that consistent engagement in activities that promote CR buildup over a life span are methods for improving AD and dementia health outcomes.
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