Olanzapine versus placebo in the treatment of psychosis with or without associated behavioral disturbances in patients with Alzheimer's disease

Deyn, Peter Paul De; Carrasco, M.M.; Deberdt, Walter; Jeandel, Claude; Hay, Donald P.; Feldman, Peter D.; Young, C.A.; Lehman, Deborah; Breier, Alan

doi:10.1002/gps.1032

Cited by 166 publications

(143 citation statements)

References 47 publications

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“…The effectiveness of antipsychotic medication for psychosis, agitation and aggression in dementia has been demonstrated in some studies (Brodaty et al, 2003;Cummings et al, 2002;De Deyn et al, 2004), but the results are contradictory as other studies have reported no effect of antipsychotic medication for NPS (Schneider et al, 2006). In reviews and meta-analyses the effect of atypical antipsychotic medication was demonstrated for risperidone (reducing aggression and psychosis) and aripiprazol (reducing aggression and psychosis), but the effect of the medication has to be balanced by the side effects of the medication (Ballard and Corbett, 2010).…”

Section: Antipsychotic Medicationmentioning

confidence: 99%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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ObjectiveThe Severe Impairment Battery (SIB) is developed to test cognitive function in patients with dementia of moderate to severe degree. We have conducted a study to assess the inter‐rater reliability and the validity of the Norwegian version of SIB.MethodsThe reliability study comprised 30 patients, and the validity study 59 patients in nursing homes. We assessed Cronbach's alpha coefficient of the scale and the inter‐rater reliability for the total SIB score and its nine sub scores between two testers by means of the Spearman's correlation coefficients. In the validity study we compared the SIB scores with the scores on the Clinical Dementia Rating Scale.ResultsThe mean SIB score was 72.10 (SD 25.37). The Cronbach's alpha was 0.97, and the inter‐rater reliability of total SIB score was Spearman's rho 0.85, and ranged from 0.46 to 0.76 for the nine sub‐scores. The mean SIB score for patients with a CDR score < 2 was 84.2(13.4), whereas total scores for patients with CDR 2 and 3 were 74 (18.9) and 48.4 (33.3), respectively. A cut‐off point of 80.5 points gave the highest accuracy in discriminating between patients with CDR 2 and CDR 3, while a cut‐off point of 87.5 best discriminated between CDR < 2 and CDR 3.ConclusionThe study indicates that the Norwegian version of SIB is a reliable and valid test with which to evaluate the cognition in patients with dementia of moderate to severe degree. Copyright © 2008 John Wiley & Sons, Ltd.

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Section: Antipsychotic Medicationmentioning

confidence: 99%

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Bergh

Selbæk

Engedal

2008

Int J Geriat Psychiatry

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“…8 This deterioration may, however, be explained by sedation 9 or the lower baseline cognition in the quetiapine group. 10 Studies of the atypical olanzapine have reported mixed results, ranging from no effect 11 to enhancing 12 or worsening cognition. 13 RCTs using risperidone for neuropsychiatric symptoms in dementia have, however, consistently found it to be effective without cognitive side effects.…”

mentioning

confidence: 99%

Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study

Livingston

Walker

Cooper

2007

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: To investigate in a longitudinal cohort of people with Alzheimer's disease whether taking antipsychotics is associated with more rapid cognitive deterioration. Method: From a sample of 224 people with Alzheimer's disease recruited as epidemiologically representative, those taking antipsychotic drugs for more than 6 months were compared with those who were not, in terms of change in three measures of cognition. The effects of potential mediators and confounders (demographic factors, neuropsychiatric symptoms, cognitive severity and cholinesterase inhibitors) were also examined. Results: No significant difference was observed in cognitive decline between those taking antipsychotics (atypical or any) and others on any measure of cognition. The only predictor of more cognitive decline was greater baseline cognitive severity (B = 3.3, 95% confidence interval 0.6 to 6

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“…Foram identificados nove ECR controlados com placebo, sendo quatro estudos com risperidona (De Deyn et al, 1999;Katz et al, 1999;Brodaty et al, 2003;Mintzer et al, 2006), dois com olanzapina (Street et al, 2000;De Deyn et al, 2004), um com risperidona e olanzapina (Debert et al, 2005), um com quetiapina (Ballard et al, 2005) e um com aripiprazol (De Deyn et al, 2005). Todos os ECR identificados foram incluídos nas metanálises, e suas características estão descritas na Tabela 1.…”

Section: Resultsunclassified

“…De Deyn et al (2004) avaliaram a eficácia de doses fixas de olanzapina (1; 2,5; 5 ou 7,5mg/dia) no tratamento de sintomas psicóticos de 652 idosos durante dez semanas. Não houve diferença entre os grupos olanzapina e placebo.…”

Section: Olanzapinaunclassified

Eficácia e segurança dos antipsicóticos atípicos nas demências: uma revisão sistemática

Ramos¹,

Rocha²

2006

J. bras. psiquiatr.

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ResumoObjetivo: O emprego de antipsicóticos atípicos (AA) no tratamento de sintomas psicológicos e comportamentais das demências (SPCD) tem sido alvo de discussão em relação à eficácia e à segurança. O objetivo deste artigo é propiciar atualização sobre o tema. Métodos: Revisão da literatura publicada nos últimos dez anos com ênfase em metanálises e ensaios clínicos randomizados (ECR) controlados com placebo. Resultados: Três metanálises e nove ensaios clínicos foram analisados. Há evidências de eficácia clínica para risperidona (1mg/dia), olanzapina (5 a 10mg/dia) e aripiprazol (2 a 15mg/dia) no tratamento de agressividade e/ou SPCD em geral, e para risperidona (1mg/dia) no tratamento de sintomas psicóticos associados à demência. Os eventos adversos comuns com o uso de AA foram sonolência, sintomas extrapiramidais (SEP), incontinência ou infecção do trato urinário e alterações de marcha. O tratamento com AA associou-se a maior risco de eventos cerebrovasculares e de mortalidade em idosos com demência. Conclusão: Baixas dosagens de risperidona, olanzapina e aripiprazol são eficazes na redução de agressividade e/ou SPCD globais; risperidona é eficaz na redução de sintomas psicóticos associados à demência. Em virtude de esses tratamentos associarem-se a pequeno aumento no risco de eventos cerebrovasculares e mortalidade, seu uso deve ser reservado para sintomatologia moderada/grave. Palavras-chave: demência, antipsicóticos atípicos, sintomas neuropsiquiátricos. AbstractObjective: Concerns have been raised about efficacy and adverse events of atypical antipsychotics in the treatment of behavioural and psychological symptoms of dementia (BPSD). This paper is an update on current evidence of this theme. Methods: Review of published meta-analysis and randomized placebo-controlled trials (RCTs) in the last ten years. Results: Three meta-analysis and nine RCTs were evaluated. Evidence suggests that risperidone (1mg/day), olanzapine (5 to 10mg/day), and aripiprazole (2 to 15mg/day) are effective in treating aggression and/or BPSD overall; risperidone (1mg/day) reduces psychosis. Adverse events were mainly somnolence, extrapyramidal symptoms, urinary tract infection or incontinence, and abnormal gait with drug treatment. Atypical antipsychotics were associated with increased risk for cerebrovascular adverse events and mortality in elderly patients with dementia. Conclusion: Low doses of risperidone, olanzapine, and aripiprazole are effective in treating aggression and/or BPSD overall, and risperidone reduces psychosis associated with dementia. In view of the increased risk of cerebrovascular adverse events and mortality, the use of atypical antipsychotics in individuals with dementia should be reserved for patients with moderate/severe behavioural symptoms.

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Olanzapine versus placebo in the treatment of psychosis with or without associated behavioral disturbances in patients with Alzheimer's disease

Abstract: While 1.0 mg olanzapine did not show significant differences from placebo, the 2.5 mg dose was a reasonable starting dose. Olanzapine at 7.5 mg/day significantly decreased psychosis and overall behavioral disturbances (NPI/NH, BPRS) and was well tolerated.

Cited by 166 publications

References 47 publications

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Reliability and validity of the Norwegian version of the Severe Impairment Battery (SIB)

Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study

Eficácia e segurança dos antipsicóticos atípicos nas demências: uma revisão sistemática

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