Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

Seitz, Dallas; Gill, Sudeep S.; Herrmann, Nathan; Brisbin, Sarah; Rapoport, Mark J.; Rines, Jenna; Wilson, Kimberley; Clair, Ken Le; Conn, David

doi:10.1017/s1041610212001627

Cited by 109 publications

(99 citation statements)

References 116 publications

(318 reference statements)

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“…In particular, given the limited efficacy and high rate of adverse effects of psychotropic medication [45,46], as well as the burden of neuropsychiatric symptoms [47], the current program could be considered as an add-on therapy in a community setting.…”

Section: Discussionmentioning

confidence: 99%

Moderate-to-High Intensity Physical Exercise in Patients with Alzheimer’s Disease: A Randomized Controlled Trial

Hoffmann

Sobol

Frederiksen

et al. 2016

JAD

242

260

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Abstract.Background: Studies of physical exercise in patients with Alzheimer's disease (AD) are few and results have been inconsistent. Objective: To assess the effects of a moderate-to-high intensity aerobic exercise program in patients with mild AD. Methods: In a randomized controlled trial, we recruited 200 patients with mild AD to a supervised exercise group (60-min sessions three times a week for 16 weeks) or to a control group. Primary outcome was changed from baseline in cognitive performance estimated by Symbol Digit Modalities Test (SDMT) in the intention-to-treat (ITT) group. Secondary outcomes included changes in quality of life, ability to perform activities of daily living, and in neuropsychiatric and depressive symptoms. Results: The ITT analysis showed no significant differences between intervention and control groups in change from baseline of SDMT, other cognitive tests, quality of life, or activities of daily living. The change from baseline in Neuropsychiatric Inventory differed significantly in favor of the intervention group (mean: -3.5, 95% confidence interval (CI) -5.8 to -1.3, p = 0.002). In subjects who adhered to the protocol, we found a significant effect on change from baseline in SDMT as compared with the control group (mean: 4.2, 95% CI 0.5 to 7.9, p = 0.028), suggesting a dose-response relationship between exercise and cognition. * Correspondence to: Professor, DMSc, MD, Steen G. K. Hoffmann et al. / Aerobic exercise in Alzheimer's diseaseConclusions: This is the first randomized controlled trial with supervised moderate-to-high intensity exercise in patients with mild AD. Exercise reduced neuropsychiatric symptoms in patients with mild AD, with possible additional benefits of preserved cognition in a subgroup of patients exercising with high attendance and intensity.

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Section: Discussionmentioning

confidence: 99%

Moderate-to-High Intensity Physical Exercise in Patients with Alzheimer’s Disease: A Randomized Controlled Trial

Hoffmann

Sobol

Frederiksen

et al. 2016

JAD

242

260

View full text Add to dashboard Cite

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“…Analgesics (Pieper, 2013) Only one RCT which had very few reported adverse events (three participants were excluded because of drowsiness and nausea) and similar loss to follow-up in intervention and control group. Mood stabilizers (Divalproex) (Seitz, 2013) Similar or lower rates of withdrawals overall and withdrawals due to adverse events with divalproex compared to placebo in the two RCTs.…”

Section: Pharmacological Interventionsmentioning

confidence: 92%

An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia

Dyer

Harrison

Laver

et al. 2017

Int. Psychogeriatr.

259

198

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“…Evidence for the efficacy of these medications is conflicting,31, 32 and the harms of some, such as antipsychotics and benzodiazepines, make them potentially inappropriate in this population 33…”

Section: Introductionmentioning

confidence: 99%

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

Page

Potter

Clifford

et al. 2016

Internal Medicine Journal

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BackgroundMedication management for people living with dementia is a complex task as it is unclear what constitutes optimal medication management in this population due to the shifting focus of health priorities and the balance between the benefits and harms of medications.AimThis study sought expert opinion to create a consensus list to define appropriate medication management of co‐morbidities for people with dementia.MethodsThis study used the Delphi technique. We invited multidisciplinary experts in geriatric therapeutics including pharmacists, doctors, nurse practitioners, a patient advocate and a psychologist to participate. Participants were asked to engage into three or more rounds of questioning. Round 1 was a questionnaire comprised of one question defining dementia and seven open‐ended questions about appropriate management of co‐morbidities in people with dementia. Two investigators qualitatively analysed the responses to questions from Round 1 using thematic analysis. The results of this analysis were provided to participants as statements in the Round 2 survey. The participants were asked to rate their agreement with each statement on a 5‐point Likert scale. The median and interquartile range (IQR) were calculated for the responses to each statement. Consensus was pre‐specified as an IQR less than or equal to 1. Statements where consensus was not achieved were presented to participants in Round 3. The Round 2 median and IQR values were provided and participants were again asked to rate their agreement with each statement on a 5‐point Likert scale. The statements where participants agreed or strongly agreed were included in the Medication Appropriateness Tool for Co‐morbid Health conditions in Dementia criteria.ResultsFifty‐seven experts agreed to participate in the study, of whom 58% were pharmacists and 36% were medical practitioners. Fifty‐five participants completed the Round 1 (95% response rate). A total of 128 statements was included in the Round 2 survey. Consensus was reached on 93 statements in Round 2 (n = 48 responders, 84% response rate) and on 18 statements in Round 3 (n = 43 responders, 75% response rate). The participants reached consensus on 111 of 128 statements. Of these statements, 67 statements were included in the Medication Appropriateness Tool for Co‐morbid Health conditions in Dementia criteria. The statements were in the broad themes of preventative medication, symptom management, disease progression, psychoactive medication, treatment goals, principles of medication use, side‐effects and medication reviews.DiscussionThis research provides consensus‐based guidance for clinicians who manage co‐morbid health conditions in people with dementia.

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Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review

Cited by 109 publications

References 116 publications

Moderate-to-High Intensity Physical Exercise in Patients with Alzheimer’s Disease: A Randomized Controlled Trial

Moderate-to-High Intensity Physical Exercise in Patients with Alzheimer’s Disease: A Randomized Controlled Trial

An overview of systematic reviews of pharmacological and non-pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia

Medication appropriateness tool for co‐morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel

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