Some drugs slightly improve cognition in people with dementia; effects on behavioral or psychological symptoms remain unclear

Reference

Fink HA, Linskens EJ, MacDonald R, et al. Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia. A systematic review and meta-analysis. Ann Intern Med 2020;172(10):656-668.

Synopsis

These authors searched 4 databases, including the Cochrane Library, along with a clinical trials database and bibliographies of other systematic reviews, to identify all English-language studies of drug treatment to treat cognition, function, or behavioral and psychological symptoms associated with Alzheimer's-type dementia. Two authors screened possible articles for inclusion. One author performed data extraction, which was verified by a second author. The authors assessed risk of bias and only analyzed results from studies with low or medium risk, removing 97 of the 163 unique studies they identified. Regarding cognition, the researchers found a small improvement (standardized mean difference 0.30) with a low strength of evidence, though no effect on overall function or global clinical impression, with cholinesterase inhibitors. The most frequently studied cholinesterase inhibitor was donepezil (Aricept). In patients with moderate to severe disease, adding memantine to a cholinesterase inhibitor improved cognition and overall clinical impression, but not function as compared with placebo. No treatments had sufficient evidence of their benefit on behavioral or psychological symptoms. Withdrawal from treatment because of side effects was higher with cholinesterase inhibitors, primarily galantamine (Razadyne, Reminyl) and rivastigmine (Exelon), as compared with placebo. There was not significant heterogeneity among the studies. The likelihood of publication bias was not reported. .