PMID- 25024323
OWN - NLM
STAT- MEDLINE
DCOM- 20150825
LR  - 20140917
IS  - 1875-8908 (Electronic)
IS  - 1387-2877 (Linking)
VI  - 42
IP  - 3
DP  - 2014
TI  - The efficacy and safety of atypical antipsychotics for the treatment of dementia: 
      a meta-analysis of randomized placebo-controlled trials.
PG  - 915-37
LID - 10.3233/JAD-140579 [doi]
AB  - BACKGROUND: The application of atypical antipsychotics (SGAs) for treatment of 
      psychiatric and behavioral symptoms of dementia is controversial since their 
      efficacy might be offset by their adverse events (AEs). OBJECTIVE: To assess the 
      efficacy, safety, and tolerability of SGAs for treatment of psychological and 
      behavioral symptoms of dementia. METHODS: Two researchers searched MEDLINE, 
      PsychINFO, and the Cochrane Central Register of Controlled Trials independently 
      for double-blind, placebo-controlled, randomized controlled trials (DB-PC-RCTs) 
      as of June 2013, written in English. Efficacy was measured using the Brief 
      Psychiatric Rating Scale (BPRS), Cohen-Mansfield Agitation Inventory (CMAI), 
      Neuropsychiatric Inventory (NPI), Clinical Global Impression of Change (CGI-C), 
      and (or) Clinical Global Impression of Severity (CGI-S). Safety and tolerability 
      were measured by frequencies of drop-outs, AEs, and death. In total, 19 treatment 
      comparisons drawn from 16 DB-PC-RCTs were included, and 3,343 patients randomized 
      to the antipsychotic group and 1,707 to the placebo group were assessed. RESULTS: 
      This meta-analysis demonstrated a significant efficacy of atypical antipsychotics 
      on BPRS (MD = -1.58, 95% CI = -2.52 - -0.65), CMAI (-1.84, -3.01 - -0.61), NPI 
      (-2.81, -4.35 - -1.28), CGI-C (-0.32, -0.44 - -0.20), and CGI-S (-0.19, -0.30 - 
      -0.09), compared to placebo (p < 0.01 for all). Patients receiving atypical 
      antipsychotics showed no difference in risk for discontinuation (p > 0.05), 
      significantly higher risks (p < 0.05 for all) for somnolence (OR = 2.95), 
      extrapyramidal symptoms (1.74), cerebrovascular AEs (2.50), urinary tract 
      infection (1.35), edema (1.80), gait abnormality (3.35), and death (1.52), and a 
      lower risk for agitation (OR = 0.80, p = 0.03). CONCLUSIONS: The higher risks for 
      AEs and mortality may offset the efficacy of atypical antipsychotics for 
      treatment of dementia. Efficacy, safety, and tolerability thus should be 
      carefully considered against clinical need.
FAU - Ma, Hui
AU  - Ma H
AD  - Department of Psychiatry, The First Affiliated Hospital of China Medical 
      University, Shenyang, China Center for Mental Health, Yanshan University, 
      Qinhuangdao, China.
FAU - Huang, Yinglin
AU  - Huang Y
AD  - Department of Psychiatry, The First Affiliated Hospital of China Medical 
      University, Shenyang, China Department of Psychiatry, Shengjing Hospital of China 
      Medical University, Shenyang, China.
FAU - Cong, Zhengtu
AU  - Cong Z
AD  - Department of Psychiatry, The First Affiliated Hospital of China Medical 
      University, Shenyang, China.
FAU - Wang, Yuan
AU  - Wang Y
AD  - Department of Psychiatry, The First Affiliated Hospital of China Medical 
      University, Shenyang, China.
FAU - Jiang, Wenhai
AU  - Jiang W
AD  - The Third People's Hospital of Daqing, Daqing, China.
FAU - Gao, Shuhe
AU  - Gao S
AD  - The Third People's Hospital of Daqing, Daqing, China.
FAU - Zhu, Gang
AU  - Zhu G
AD  - Department of Psychiatry, The First Affiliated Hospital of China Medical 
      University, Shenyang, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - J Alzheimers Dis
JT  - Journal of Alzheimer's disease : JAD
JID - 9814863
RN  - 0 (Antipsychotic Agents)
SB  - IM
MH  - Antipsychotic Agents/*therapeutic use
MH  - Behavioral Symptoms/*drug therapy/etiology
MH  - Databases, Bibliographic/statistics & numerical data
MH  - Dementia/complications/*drug therapy
MH  - Humans
MH  - Neuropsychological Tests
MH  - Psychiatric Status Rating Scales
MH  - Psychotic Disorders/*drug therapy/etiology
MH  - *Randomized Controlled Trials as Topic
OTO - NOTNLM
OT  - Antipsychotic
OT  - clinical trial
OT  - dementia
OT  - meta-analysis
EDAT- 2014/07/16 06:00
MHDA- 2015/08/26 06:00
CRDT- 2014/07/16 06:00
PHST- 2014/07/16 06:00 [entrez]
PHST- 2014/07/16 06:00 [pubmed]
PHST- 2015/08/26 06:00 [medline]
AID - 06835N9K737471W2 [pii]
AID - 10.3233/JAD-140579 [doi]
PST - ppublish
SO  - J Alzheimers Dis. 2014;42(3):915-37. doi: 10.3233/JAD-140579.