%0 Journal Article
%T Comparative efficacy of interventions for aggressive and agitated behaviors in dementia: a systematic review and network meta-analysis
%J Annals of internal medicine
%D 2019
%A Watt, Jennifer A.
%A Goodarzi, Zahra
%A Veroniki, Areti Angeliki
%A Nincic, Vera
%A Khan, Paul A.
%A Ghassemi, Marco
%A Thompson, Yuan
%A Tricco, Andrea C.
%A Straus, Sharon E.
%V ePub
%N ePub
%P ePub-ePub
%X BACKGROUND: Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia. <br><br>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. <br><br>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).<p /> <p>Language: en</p>
%G en
%I American College of Physicians
%@ 0003-4819
%U http://dx.doi.org/10.7326/M19-0993