Interventions for the treatment of behavioural and psychological symptoms of dementia: An overview

Behavioural and psychological symptoms of dementia (BPSD) are common amongst people with dementia and can have a large impact on public health by potentially reducing quality of life, increasing caregiver impact and increasing costs associated with dementia care. The objective of this study was to synthesise the findings of systematic reviews of randomised controlled trials of interventions for the treatment of BPSD (PROSPERO CRD42016039477). A systematic search of The Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE and PsycINFO retrieved 3467 citations. Systematic reviews of randomised controlled trials of interventions aimed at treating BPSD in patients with dementia of any type including Alzheimer’s disease or Alzheimer’s disease only were included. The most comprehensive and upto-date reviews for acetylcholinesterase inhibitors, antipsychotics, antidepressants, benzodiazepines, mood stabilisers, melatonin, caregiver interventions, exercise, music therapy, cognitive stimulation and psychological interventions were included. For the majority of the interventions, included reviews were of moderate to high quality according to the AMSTAR checklist and the evidence was of low to moderate quality as rated using GRADE criteria. Reported effect sizes for atypical antipsychotics on global BPSD measures were very small (SMD 0.17, 95%CI 0.08 to 0.25; moderate quality evidence). Cognitive enhancers also had very small effects; reviews reported non-significant trends in favour of donepezil or memantine (4 and 2 studies, respectively) and a small but significant effect for galantamine based on high quality evidence from two studies. Effect sizes have been compared across interventions and interpreted in light of the severity of dementia in study populations.