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

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          ABSTRACT

          Background:

          This systematic overview reports findings from systematic reviews of randomized controlled trials of pharmacological and non-pharmacological interventions for behavioural and psychological symptoms of dementia (BPSD).

          Methods:

          The Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE, and PsycINFO were searched to September 2015.

          Results:

          Fifteen systematic reviews of eighteen different interventions were included. A significant improvement in BPSD was seen with: functional analysis-based interventions (GRADE quality of evidence moderate; standardized mean difference (SMD) −0.10, 95%CI −0.20 to 0.00), music therapy (low; SMD −0.49, 95%CI −0.82 to −0.17), analgesics (low; SMD −0.24, 95%CI −0.47 to −0.01), donepezil (high; SMD −0.15 95% CI −0.29 to −0.01), galantamine (high; SMD −0.15, 95%CI −0.28 to −0.03), and antipsychotics (high; SMD −0.13, 95%CI −0.21 to −0.06). The estimate of effect size for most interventions was small.

          Conclusions:

          Although some pharmacological interventions had a slightly larger effect size, current evidence suggests functional analysis-based interventions should be used as first line management of BPSD whenever possible due to the lack of associated adverse events. Music therapy may also be beneficial, but further research is required as the quality of evidence to support its use is low. Cholinesterase inhibitors donepezil and galantamine should be trialled for the management of BPSD where non-pharmacological treatments have failed. Low-quality evidence suggests that assessment of pain should be conducted and a stepped analgesic approach trialled when appropriate. Antipsychotics have proven effectiveness but should be avoided where possible due to the high risk of serious adverse events and availability of safer alternatives.

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          Most cited references11

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          Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population.

          Behavioural and psychological symptoms of dementia (BPSD) are major contributors to the burden of dementia. To describe the prevalence, correlates and course of BPSD in the population of England and Wales. The prevalence of 12 symptoms was estimated in 587 participants with dementia and 2050 participants without dementia as part of a population-based longitudinal study of ageing. The effect of risk factors and the factor structure were estimated using 1782 interviews provided by participants with dementia throughout the study. Each symptom apart from sleeping problems was more common in the population with dementia. The co-occurrence of the symptoms was explained by a four-factor solution, corresponding to psychosis/apathy, depression/anxiety, irritability/persecution and wandering/sleep problems. Psychosis occurred more frequently with declining cognition. Anxiety and depression were more common in younger individuals and in those with poor self-reported health. Persistence varied between symptoms. Behavioural and psychological symptoms of dementia affect nearly all people with dementia. Symptoms co-occur, and the symptoms that affected individuals experience are related to their socio-demographic and clinical characteristics.
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            Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease.

            Two hundred ten community-dwelling patients with Alzheimer's disease were examined prospectively by psychiatrists as part of a longitudinal study. Twenty-five of these patients who were institutionalized during the next 3 years were then matched to 25 patients who were not institutionalized, and the groups were compared. The patients who had been institutionalized had higher scores on standardized psychiatric rating scales but not on formal neuropsychological tests of cognition. These results suggest that potentially treatable (noncognitive) behavioral and psychiatric symptoms are risk factors for institutionalization, and that treating these symptoms might delay or prevent institutionalization of some patients.
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              Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis.

              Behavioral and psychological symptoms of dementia (BPSD) are common problems for patients and caregivers. Although music therapy is considered a non-pharmacological intervention for the management of BPSD, its effectiveness remains unclear. This study aimed to investigate the effects of music therapy on BPSD, cognitive function, and activities of daily living in patients with dementia. A literature search was conducted in the following databases: MEDLINE, CINAHL, PsycINFO, and Igaku Chuo Zasshi. We selected 20 studies, including randomized controlled trials, controlled clinical trials, cohort studies, and controlled trials, and conducted a meta-analysis using standardized mean differences (SMD). The results showed that music therapy had moderate effects on anxiety [SMD, -0.64; 95% confidence interval (CI), -1.05 - -0.24; p=0.002] and small effects on behavioral symptoms (SMD, -0.49; 95% CI, -0.82 - -0.17; p=0.003). In studies of duration >3 months, music therapy had large effects on anxiety (SMD, -0.93; 95% CI, -1.72 - -0.13; p=0.02). The present systematic review and meta-analysis suggests that music therapy is effective for the management of BPSD. Copyright © 2013 Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                applab
                International Psychogeriatrics
                Int. Psychogeriatr.
                Cambridge University Press (CUP)
                1041-6102
                1741-203X
                March 2018
                November 16 2017
                March 2018
                : 30
                : 03
                : 295-309
                Article
                10.1017/S1041610217002344
                29143695
                d7524515-b787-49b3-b177-c583fb124d9a
                © 2018
                History

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