Abstract
Background
Antipsychotic drugs are often used to treat behavioral and psychological symptoms
(BPSD) in adults aged 65 years and older with dementia, although there is uncertainty
about the effectiveness of long-term use for this indication and there are concerns
that they may cause harm.
Objectives
To evaluate whether discontinuation of long-term antipsychotic drugs for BPSD is successful
in adults aged 65 years and older with dementia. This article is based on a Cochrane
review updated in 2018.
Design
A Cochrane systematic review and meta-analysis.
Setting and Participants
Eight databases were searched in January 2018 to identify 10 randomized controlled
trials with 632 older adults.
Measures
We used standard methodological procedures according to the Cochrane Handbook for
Systematic Reviews of Interventions. We assessed the number of patients completing
the study. We considered sustained withdrawal of antipsychotics until the end of the
study period as successful outcome.
Results
Based on assessment of 7 studies (n = 446), discontinuation may make little or no
difference to whether or not participants complete the study (low-quality evidence).
In 2 trials, including participants with psychosis, agitation, or aggression who had
responded to antipsychotic treatment, discontinuation of antipsychotics was associated
with a higher risk of leaving the study prematurely because of symptomatic relapse
or a shorter time to symptomatic relapse. We found low-quality evidence from 7 trials
(n = 519) that discontinuation may make little or no difference to overall BPSD, measured
using various scales. There was some evidence from subgroup analyses in 2 trials that
discontinuation may be associated with a worsening of BPSD in participants with more
severe BPSD at baseline.
Conclusions
Our meta-analysis revealed that there is low-quality evidence that long-term antipsychotic
drugs for BPSD may be successfully discontinued in most adults aged 65 and older.
Keywords
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Article info
Publication history
Published online: August 09, 2018
Footnotes
This research did not receive any funding from agencies in the public, commercial or for non-profit sectors.
This Cochrane review update was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to the Cochrane Dementia and Cognitive Improvement group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Program, NIHR, National Health Service or the Department of Health.
This article is based on the Cochrane Review on withdrawal vs continuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older people with dementia.
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
