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 and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF]
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: 15 January 2008
Readers of this article also read:
Small airway dysfunction and flow and volume bronchodilator responsiveness in patients with chronic obstructive pulmonary disease
Pisi R, Aiello M, Zanini A, Tzani P, Paleari D, Marangio E, Spanevello A, Nicolini G, Chetta A
Published Date: 19 June 2015
Efficacy and safety of ramosetron versus ondansetron for postoperative nausea and vomiting after general anesthesia: a meta-analysis of randomized clinical trials
Gao CJ, Li B, Xu LF, Lv FB, Cao GM, Wang HX, Wang F, Wu GH
Published Date: 23 April 2015
Sandoo A, Kitas GD, Carmichael AR
Published Date: 7 April 2015
Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection
Gao F, Ye QF, Wan QQ, Liu S, Zhou JD
Published Date: 26 March 2015
The COPD assessment test correlates well with the computed tomography measurements in COPD patients in China
Zhang Y, Tu YH, Fei GH
Published Date: 5 March 2015
Effectiveness and tolerability of second-line treatment with vildagliptin versus other oral drugs for type 2 diabetes in a real-world setting in the Middle East: results from the EDGE study
Saab C, Al-Saber FA, Haddad J, Jallo MK, Steitieh H, Bader G, Ibrahim M
Published Date: 24 February 2015
Targeted lung cancer therapy: preparation and optimization of transferrin-decorated nanostructured lipid carriers as novel nanomedicine for co-delivery of anticancer drugs and DNA
Shao Z, Shao J, Tan B, Guan S, Liu Z, Zhao Z, He F, Zhao J
Published Date: 11 February 2015
Effects of extended-release niacin/laropiprant, simvastatin, and the combination on correlations between apolipoprotein B, LDL cholesterol, and non-HDL cholesterol in patients with dyslipidemia
Farnier M, Chen E, Johnson-Levonas AO, McCrary Sisk C, Mitchel YB
Published Date: 7 May 2014
Clinical benefit of fixed-dose dual bronchodilation with glycopyrronium and indacaterol once daily in patients with chronic obstructive pulmonary disease: a systematic review
Published Date: 1 April 2014
Facet-sparing lumbar decompression with a minimally invasive flexible MicroBlade Shaver® versus traditional decompression: quantitative radiographic assessment
Lauryssen C, Berven S, Mimran R, Summa C, Sheinberg M, Miller LE, Block JE
Published Date: 20 July 2012