Seitz_2012_Int.Psychogeriatr__1

ABSTRACT Background Medications are frequently prescribed for neuropsychiatric symptoms NPS associated with dementia although information on the efficacy and safety of medications for NPS specifically in long-term care LTC settings is limited The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC Methods We searched MEDLINE EMBASE PsychINFO and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC Study quality was described using the Cochrane collaboration risk of bias tool The efficacy of medications was evaluated using NPS symptom rating scales Safety was evaluated through rates of trial withdrawals trial withdrawals due to adverse events and mortality Results A total of 29 studies met inclusion criteria The most common medications evaluated in studies were atypical antipsychotics N 15 typical antipsychotics N 7 anticonvulsants N 4 and cholinesterase inhibitors N 3 Statistically significant improvements in NPS were noted in some studies evaluating risperidone olanzapine and single studies of aripiprazole carbamazepine estrogen cyproterone propranolol and prazosin Study quality was difficult to rate in many cases due to incomplete reporting of details Some studies reported higher rates of trial withdrawals adverse events and mortality associated with medications Conclusions We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations However the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.