Atypicals for Dementia a Modest Help with Behavior Problems

By Wachter, Kerri | Clinical Psychiatry News, May 2006 | Go to article overview

Atypicals for Dementia a Modest Help with Behavior Problems


Wachter, Kerri, Clinical Psychiatry News


SAN JUAN, P.R. -- Atypical antipsychotics appear to have a modest effect on behavioral symptoms in elderly patients with dementia, but the effectiveness of nonpharmacologic treatments is less clear, according to a metaanalysis presented at the annual meeting of the American Association for Geriatric Psychiatry.

Dr. Mark B. Snowden of the department of psychiatry and behavioral sciences at the University of Washington in Seattle and his colleagues used metaanalysis techniques to compare the efficacy of nonpharmacologic treatments with that of pharmacologic therapies.

Articles from peer-reviewed, English language publications, including textbooks, from 1970 on were considered for the analysis. Nursing home residents had to make up at least half of the populations being studied. In addition to literature searches in several medical and nursing databases, the researchers submitted articles that they were aware of but that had not previously been identified. Articles were included only if they documented randomized, controlled trials.

The researchers identified five randomized, controlled trials of antipsychotic drugs and three randomized, controlled trials for nonpharmacologic interventions. The drug trials included four atypical drugs and one traditional antipsychotic drug.

The nonpharmacologic trials included 8 hours of nurses' aide training to communicate more effectively with patients with dementia, 8 hours of education/training with weekly follow-ups and hands-on activities of daily living care, 3 hours per day of psychosocial activities, and combined nonpharmacologic approaches.

The calculated effect size for nonpharmacologic interventions was -.088, which was not statistically significant. In comparison, the calculated effect size for pharmacologic interventions was -.23, which "would be considered small to modest at best," Dr. Snowden said. "In this instance, the finding was consistent enough across studies that it is statistically significant. …

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