BMJ  2004;329:75 (10 July), doi:10.1136/bmj.38125.465579.55 (published 11 June 2004)

Paper

Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review

Philip E Lee, behavioural neurology fellow1, Sudeep S Gill, adjunct scientist and geriatrician2, Morris Freedman, behavioural neurologist3, Susan E Bronskill, scientist2, Michael P Hillmer, doctoral candidate4, Paula A Rochon, senior scientist and assistant director4

1 Rotman Research Institute, Baycrest Centre for Geriatric Care, 3560 Bathurst Street, Toronto, ON, Canada M6A 2E1, 2 Institute for Clinical Evaluative Sciences (ICES), 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5, 3 Department of Medicine (Neurology), University of Toronto, 190 Elizabeth Street, Toronto, ON, Canada M5G 2C4, 4 Kunin-Lunenfeld Applied Research Unit (KLARU), Baycrest Centre for Geriatric Care

Correspondence to: P Lee pelee{at}providencehealth.bc.ca

Objective To review the role of oral atypical antipsychotic drugs in the management of the behavioural and psychological symptoms of dementia (BPSD).

Data sources Medline, Embase, and the Cochrane Library. Reference lists were reviewed and experts were contacted to identify additional trials.

Study selection Double blind randomised controlled trials that evaluated the four oral atypical antipsychotic therapies for BPSD.

Review methods Two reviewers assessed trial validity independently.

Data extraction Demographics of patients, study duration, dose of antipsychotic, primary end points, adverse events.

Results 77 abstracts were reviewed. Five randomised trials (1570 patients) evaluating risperidone and olanzapine were identified. The quality of trials was generally good. Most participants were in an institution (> 96%), elderly (weighted mean 82.3 years), and had Alzheimer's disease (76.3%). Trials lasted 6-12 weeks. Treatment with atypical antipsychotic drugs was superior to placebo for the primary end point in three of the five trials. Two trials comparing risperidone with haloperidol did not find any differences in the primary measures of efficacy. Adverse events were common and included extrapyramidal symptoms, somnolence, and abnormal gait.

Conclusions Although atypical antipsychotic drugs are being used with increasing frequency, few randomised trials have evaluated their use for BPSD. Limited evidence supports the perception of improved efficacy and adverse event profiles compared with typical antipsychotic drugs.


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