PMID- 16245958
OWN - NLM
STAT- MEDLINE
DCOM- 20060120
LR  - 20181201
IS  - 1170-229X (Print)
IS  - 1170-229X (Linking)
VI  - 22
IP  - 10
DP  - 2005
TI  - Antipsychotics for behavioural and psychological problems in elderly people with 
      dementia: a systematic review of adverse events.
PG  - 845-58
AB  - OBJECTIVE: Although antipsychotics are important in the treatment of behavioural 
      and psychological symptoms of dementia (BPSD), they have moderate efficacy and 
      often cause adverse events. Recent safety warnings about increased frequency of 
      cerebrovascular adverse events in elderly patients who use atypical 
      antipsychotics mean that physicians now face a dilemma when weighing the benefits 
      and risks of use of antipsychotics in this patient group. This study 
      systematically reviews the reporting of adverse events of antipsychotics used to 
      treat BPSD in randomised, controlled trials (RCTs). METHODS: We searched the 
      MEDLINE, EMBASE, PsychInfo and CINAHL databases (search period 1980 or 1986-April 
      2005) and the Cochrane controlled trials register (2005) for RCTs that used 
      intention-to-treat analysis to evaluate the efficacy and harms of antipsychotics 
      used to treat BPSD. Two independent reviewers assessed the reporting of adverse 
      events. RESULTS: Screening of 930 abstracts identified 12 eligible RCTs (2809 
      patients). Most participants were elderly people (mean age 80 years) with 
      Alzheimer's, vascular or mixed dementia. Studies lasted from 3 to 16 weeks. 
      Adverse events, though common, were described heterogeneously and incompletely. 
      No RCT fulfilled all Consolidated Standards of Reporting Trials requirements for 
      the reporting of harms. Atypical antipsychotics caused fewer extrapyramidal 
      symptoms and less somnolence than typical antipsychotics, but these differences 
      disappeared when dosages were increased. Only one trial reported cerebrovascular 
      adverse events, with a number needed to harm of 14 (95% CI 8, 41). CONCLUSIONS: 
      At lower doses atypical antipsychotics may cause fewer adverse events in the 
      treatment of BPSD, but there is uncertainty about their cerebrovascular safety 
      profile. The RCTs included in this systematic review described adverse events too 
      incompletely and heterogeneously to allow generation of clear treatment 
      recommendations, and they do not provide sufficient evidence to support recent 
      safety warnings. Better reporting on harms in RCTs is needed to enable rational 
      treatment decisions with respect to use of antipsychotics for BPSD.
FAU - van Iersel, Marianne B
AU  - van Iersel MB
AD  - Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, 
      The Netherlands.
FAU - Zuidema, Sytse U
AU  - Zuidema SU
FAU - Koopmans, Raymond T C M
AU  - Koopmans RT
FAU - Verhey, Frans R J
AU  - Verhey FR
FAU - Olde Rikkert, Marcel G M
AU  - Olde Rikkert MG
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - New Zealand
TA  - Drugs Aging
JT  - Drugs & aging
JID - 9102074
RN  - 0 (Antipsychotic Agents)
SB  - IM
MH  - Aged
MH  - Aging/*psychology
MH  - *Antipsychotic Agents/administration & dosage/adverse effects/therapeutic use
MH  - Behavior/*drug effects
MH  - Clinical Trials as Topic
MH  - Databases, Bibliographic
MH  - Databases, Factual
MH  - *Dementia/drug therapy/etiology/psychology
MH  - Humans
RF  - 51
EDAT- 2005/10/26 09:00
MHDA- 2006/01/21 09:00
CRDT- 2005/10/26 09:00
PHST- 2005/10/26 09:00 [pubmed]
PHST- 2006/01/21 09:00 [medline]
PHST- 2005/10/26 09:00 [entrez]
AID - 22104 [pii]
AID - 10.2165/00002512-200522100-00004 [doi]
PST - ppublish
SO  - Drugs Aging. 2005;22(10):845-58. doi: 10.2165/00002512-200522100-00004.