Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses

Tampi, Rajesh R.; Tampi, Deena J.; Balachandran, Silpa; Srinivasan, Shilpa

doi:10.1177/2040622316658463

Cited by 200 publications

(124 citation statements)

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“…In Japan, as in European and North American countries, risk of mortality is increased among patients with ATD receiving antipsychotics for the treatment of BPSD . Indeed, some antipsychotics aggravate extrapyramidal symptoms or autonomic failure . In future, when treating patients with DLB, it is important to explore strategies by which administration of antipsychotics can be avoided.…”

Section: Discussionmentioning

confidence: 99%

A survey of doctors on diagnosis and treatment of dementia with Lewy bodies: examination and treatment of behavioural and psychological symptoms

2019

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BackgroundDementia with Lewy bodies (DLB) is a progressive form of dementia, accompanied by a range of behavioural and psychological symptoms. The aim of this study was to identify current clinical practice for the treatment of DLB in Japan.MethodsWe conducted a survey of medical doctors engaged in the management of dementia in Japan. Participants were divided into two groups: psychiatrists (Group P) and neurologists or neurosurgeons (Group NS). Doctors completed a questionnaire and we analysed their responses to compare the two groups with regard to diagnosis and treatment of DLB, and in particular the treatment of behavioural and psychological symptoms of dementia (BPSD).ResultsResponses suggested that Group P conducted biomarker examinations less frequently and decided on their own therapeutic strategies more frequently than did Group NS. Both groups most frequently selected hallucinations/delusions as the symptoms given highest treatment priority. More than 70% of respondents in both groups reported having difficulties in treating BPSD. Atypical antipsychotics were more frequently prescribed by Group P, but were also prescribed in 70% of patients in Group NS. A third of patients received atypical antipsychotics for more than 1 year.ConclusionsThe responses to this survey highlighted the difficulties faced by clinicians managing patients with DLB and identified the need to effectively treat BPSD in such patients.

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Section: Discussionmentioning

confidence: 99%

A survey of doctors on diagnosis and treatment of dementia with Lewy bodies: examination and treatment of behavioural and psychological symptoms

2019

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“…Meta-analyses of randomized, controlled trials of APs demonstrate limited efficacy for treating DRP (14, 15). The effect size for treatment is modest (effect size=0.2) for psychosis in patients with AD (16–18).…”

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confidence: 99%

Pimavanserin: Potential Treatment for Dementia-Related Psychosis

et al. 2018

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Psychosis is common across dementia types with a prevalence of 20% to 70%. Currently, no pharmacologic treatment is approved for dementia-related psychosis. Atypical antipsychotics are frequently used to treat these disorders, despite significant safety concerns. Pimavanserin, a selective 5-HT2A inverse agonist/antagonist, was approved in the U.S. for treating hallucinations and delusions associated with Parkinson’s disease psychosis (PDP). Patients in the pimavanserin group experienced a significant (p=0.001) improvement in Scale for the Assessment of Positive Symptoms – Parkinson’s disease (SAPS-PD) scores vs. placebo. In a subgroup analysis of patients with cognitive impairment (MMSE score ≥21 but ≤24), the observed improvement on the SAPS-PD with pimavanserin (N=50) was also significant (p=0.002) and larger than in the overall study population without an adverse effect on cognition. In a Phase 2 study with pimavanserin in Alzheimer’s disease psychosis, pimavanserin significantly (p=0.045) improved psychosis at Week 6 vs. placebo on the NPI-NH Psychosis Score (PS). In a prespecified subgroup of patients with a baseline NPI-NH PS ≥12, a substantively larger treatment effect (p=0.011) was observed vs. participants with NPI-NH PS

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“…Although currently pharmacological therapies (such as antidepressants, antipsychotics, anxiolytics, anticonvulsants, and cholinesterase inhibitors) are used to reduce the frequency and severity of NPs when nonpharmacological interventions are ineffective, they provide only moderate symptoms control in most of the patients. 9,10 Additionally, they have serious adverse effects (eg sedation, postural hypotension, metabolic syndrome issues and electrolyte changes, drug interactions, cardiac arrhythmia, extrapyramidal symptoms, and falls). [10][11][12][13] Because of the complications associated with the pharmacological treatment, current guidelines recommend that nonpharmacological interventions should be attempted first, followed by the least harmful medication for the shortest time possible time.…”

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confidence: 99%

Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review

Veronese

Solmi

Basso³

et al. 2018

Int J Geriat Psychiatry

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Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses

Cited by 200 publications

References 54 publications

A survey of doctors on diagnosis and treatment of dementia with Lewy bodies: examination and treatment of behavioural and psychological symptoms

A survey of doctors on diagnosis and treatment of dementia with Lewy bodies: examination and treatment of behavioural and psychological symptoms

Pimavanserin: Potential Treatment for Dementia-Related Psychosis

Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review

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