Citation

Watt JA, Goodarzi Z, Veroniki AA, Nincic V, Khan PA, Ghassemi M, Thompson Y, Tricco AC, Straus SE. Ann. Intern Med. 2019; ePub(ePub): ePub.

Affiliation

St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.).

Copyright

(Copyright © 2019, American College of Physicians)

DOI

10.7326/M19-0993

PMID

31610547

Abstract

BACKGROUND: Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia.

PURPOSE: To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia. DATA SOURCES: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews. STUDY SELECTION: Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia. DATA EXTRACTION: Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias. DATA SYNTHESIS: After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care. LIMITATIONS: Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated.

CONCLUSION: Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia. PRIMARY FUNDING SOURCE: Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).

Language: en