ConclusionQuetiapine and rivastigmine seemed of no benefit in patients with dementia and agitation in institutional care, and quetiapine was associated with greater cognitive decline than placebo. Our results suggest that quetiapine should not be used in people with dementia and highlight concerns regarding the long term use of antipsychotics in these patients.We thank the Alzheimer's Research Trust for their support in our programme of work to evaluate the impact of antipsychotics on cognition; Alistair Burns for his helpful comments on the manuscript; and Andrea Burton for her helpful advice regarding the sensitivity analysis. Contributors: See bmj.com Funding: The study was funded largely from general donations to C Ballard's research programme and profits from previously completed commercially funded clinical trials, with additional support from the Alzheimer's Research Trust. Competing interests: C Ballard has received honorariums and research donations to support his general research programme from Astra Zeneca and Novartis. Ethical approval: The study was approved by a properly constituted local research ethics committee. One refusal (0.2%) was received. Consent rates were significantly better for children who were more severely ill on admission and for hospital stays of six days or more, and significantly poorer for children aged 10-14 years. Long hospital stays and children aged 10-14 years remained significant in a stepwise regression model of the factors that were significant in the univariate model. Conclusion Systematically obtaining individual signed consent for sharing patient identifiable information with an externally located clinical audit database is difficult. Obtaining such consent is unlikely to be successful unless additional resources are specifically allocated to training, staff time, and administrative support.
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