Dementia

Overview

Abstract | Cite as | Substantive changes

Abstract

INTRODUCTION: Dementia is characterised by chronic, global, non-reversible deterioration in memory, executive function, and personality. Speech and motor function may also be impaired. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments on cognitive symptoms of dementia (Alzheimer's, Lewy body, or vascular)? What are the effects of treatments on behavioural and psychological symptoms of dementia (Alzheimer's, Lewy body, or vascular)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine), antidepressants (clomipramine, fluoxetine, imipramine, sertraline), antipsychotics (haloperidol, olanzapine, quetiapine, risperidone), aromatherapy, benzodiazepines (diazepam, lorazepam), cognitive behavioural therapy (CBT), cognitive stimulation, exercise, ginkgo biloba, memantine, mood stabilisers (carbamazepine, sodium valproate/valproic acid), music therapy, non-steroidal anti-inflammatory drugs (NSAIDs), omega 3 (fish oil), reminiscence therapy, and statins.

Cite as

Butler R and Radhakrishnan R. Dementia. Clinical Evidence 2012; 09:1001.

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Substantive changes

Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) versus placebo in people with cognitive symptoms of dementia New evidence added[21][23][25][26][27][29] including one updated Cochrane systematic review.[22] Categorisation unchanged (Likely to be beneficial).

Ginkgo biloba versus placebo in people with cognitive symptoms of dementia New evidence added,[31][32] including one Cochrane systematic review amended.[30] Categorisation changed from Unlikely to be beneficial to Unknown effectiveness.

Memantine versus placebo in people with cognitive symptoms of dementia New evidence added.[35][36][37] Categorisation changed from Unknown Effectiveness to Likely to be beneficial.

Non-pharmacological interventions (cognitive stimulation, music therapy, reminiscence therapy) versus placebo in people with cognitive symptoms of dementia New evidence added.[40] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effectiveness of this intervention.

Omega 3 (fish oil) versus placebo in people with cognitive symptoms of dementia New evidence added.[41] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effectiveness of this intervention.

Statins versus placebo in people with cognitive symptoms of dementia New evidence added.[43] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effectiveness of this intervention.

Non-steroidal anti-inflammatory drugs (NSAIDs) versus placebo in people with cognitive symptoms of dementia New data added.[49] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effectiveness of this intervention.

Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) versus placebo in people with behavioural and psychological symptoms of dementia New evidence added.[21][26] Categorisation unchanged (Likely to be beneficial).

Antipsychotic medications (haloperidol, olanzapine, quetiapine, risperidone) versus placebo in people with behavioural and psychological symptoms of dementia New evidence added.[54][56] Categorisation unchanged (Trade-off between benefits and harms).

Memantine versus placebo in people with behavioural and psychological symptoms of dementia New evidence added.[36][62] Categorisation unchanged (Likely to be beneficial).

Non-pharmacological interventions (aromatherapy, CBT, exercise) versus placebo in people with behavioural and psychological symptoms of dementia New evidence added.[63][64][65] Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to judge the effectiveness of this intervention.

Antidepressants (clomipramine, fluoxetine, imipramine, sertraline) versus placebo in people with depression and dementia New evidence added.[67][68][69] Categorisation changed from Likely to be be beneficial to Unknown effectiveness.