Nonpharmacologic approaches are better than medication to control aggression/agitation in dementia

Référence

Watt JA, Goodarzi Z, Veroniki AA, et al. Comparative efficacy of interventions for aggressive and agitated behaviors in dementia. A systematic review and network meta-analysis. Ann Intern Med 2019;171(9):633-642.

Sommaire

The authors searched 5 databases, including Cochrane CENTRAL and bibliographies of retrieved studies, identifying 163 randomized controlled studies of 23,143 patients that compared interventions for treating aggression and agitation in adults with dementia. Two investigators independently selected, abstracted, and evaluated the studies. Almost half of the studies were categorized as being at high risk of bias, mostly because of missing outcome data. Since not every intervention is directly compared with one another, the authors performed a network analysis, which allows indirect comparisons based on a common comparator. Typical antipsychotics provided no additional benefit compared with modifying instrumental activities of daily living (which is also not more effective than usual care). Cannabinoids and dextromethorphan/quinidine were moderately more effective than instrumental activity of daily living modification. Outdoor activitiy, multidisciplinary care, and massage and touch therapy, with or without music, were effective in producing a large reduction in aggression and agitation.