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Comparative Study
. 2019 Nov 5;171(9):633-642.
doi: 10.7326/M19-0993. Epub 2019 Oct 15.

Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis

Jennifer A Watt  1 , Zahra Goodarzi  2 , Areti Angeliki Veroniki  3 , Vera Nincic  4 , Paul A Khan  4 , Marco Ghassemi  4 , Yuan Thompson  4 , Andrea C Tricco  1 , Sharon E Straus  1
Affiliations
Comparative Study

Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-analysis

Jennifer A Watt et al. Ann Intern Med. .

Abstract

Background: Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia.

Purpose: To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia.

Data sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews.

Study selection: Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia.

Data extraction: Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias.

Data synthesis: After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care.

Limitations: Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated.

Conclusion: Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia.

Primary funding source: Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).

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