Impact of cholinesterase inhibitors on behavioral and psychological symptoms of Alzheimer’s disease: A meta-analysis
Noll Campbell1, Amir Ayub2, Malaz A Boustani2, Chris Fox3, Martin Farlow4, Ian Maidment3, Robert Howard5
1Wishard Health Services, Indianapolis, Indiana; 2Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana; 3University of Kent, Kent, United Kingdom; 4Indiana University School of Medicine, Indianapolis, Indiana; 5King’s College, London, United Kingdom
Objective: To determine the efficacy of cholinesterase inhibitors (ChEIs) in improving the behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer’s disease (AD).
Data sources: We searched MEDLINE, Cochrane Registry, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1966 to 2007. We limited our search to English Language, full text, published articles and human studies.
Data extraction: We included randomized, double-blind, placebo-controlled trials evaluating the efficacy of donepezil, rivastigmine, or galantamine in managing BPSD displayed by AD patients. Using the United States Preventive Services Task Force (USPSTF) guidelines, we critically appraised all studies and included only those with an attrition rate of less than 40%, concealed measurement of the outcomes, and intention to treat analysis of the collected data. All data were imputed into pre-defined evidence based tables and were pooled using the Review Manager 4.2.1 software for data synthesis.
Results: We found 12 studies that met our inclusion criteria but only nine of them provided sufficient data for the meta-analysis. Among patients with mild to severe AD and in comparison to placebo, ChEIs as a class had a beneficial effects on reducing BPSD with a standard mean difference (SMD) of −0.10 (95% confidence interval [CI]; −0.18, −0.01) and a weighted mean difference (WMD) of −1.38 neuropsychiatry inventory point (95% CI; −2.30, −0.46). In studies with mild AD patients, the WMD was −1.92 (95% CI; −3.18, −0.66); and in studies with severe AD patients, the WMD was −0.06 (95% CI; −2.12, +0.57).
Conclusion: Cholinesterase inhibitors lead to a statistical significant reduction in BPSD among patients with AD, yet the clinical relevance of this effect remains unclear.
Keywords: Alzheimer’s disease, dementia, cholinesterase inhibitors, behavioral and psychological symptoms
This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php
Other articles by this author:
Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system
Malaz A Boustani, Stephanie Munger, Rajesh Gulati, et al
Published Date: 5 May 2010
Noll Campbell, Malaz Boustani, Tony Limbil, Carol Ott, et al.
Published Date: 13 May 2009
Malaz Boustani, Cathy Schubert, Youcef Sennour
Published Date: 3 January 2007
Readers of this article also read:
Intracameral phenylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification [Corrigendum]
Lindstrom RL, Loden JC, Walters TR, Dunn SH, Whitaker JS, Kim T, Demopulos GA, Tjia K
Published Date: 28 January 2015
Changes in background electroencephalography and regional cerebral glucose metabolism in focal epilepsy patients after 1-month administration of levetiracetam
Kim SH, Lim SC, Kim W, Kwon OH, Kim CM, Lee JM, Shon YM
Published Date: 27 January 2015
Liskova J, Babchenko O, Varga M, Kromka A, Hadraba D, Svindrych Z, Burdikova Z, Bacakova L
Published Date: 27 January 2015
Lipari M, Kale-Pradhan PB
Published Date: 18 November 2014
Published Date: 5 May 2014
Soosay Raj TA, Smith AM, Moore AS
Published Date: 5 December 2013
Mangouritsas G, Mourtzoukos S, Portaliou DM, Georgopoulos VI, Dimopoulou A, Feretis E
Published Date: 15 April 2013
Fukuda M, Shibata S, Shibata N, Hagihara K, Yaguchi H, Osada H, Takahashi N, Kubo E, Sasaki H
Published Date: 12 March 2013
Oxybutynin reduces sweating in depressed patients treated with sertraline: a double-blind, placebo-controlled, clinical study
Ghaleiha A, Jahangard L, Sherafat Z, Ahmadpanah M, Brand S, Holsboer-Trachsler E, Bajoghli H, Haghighi M
Published Date: 14 September 2012