Systematic appraisal of dementia guidelines for the management of behavioural and psychological symptoms
M Azermai, M Petrovic, MM Elseviers, J Bourgeois… - Ageing research …, 2012 - Elsevier
M Azermai, M Petrovic, MM Elseviers, J Bourgeois, LM Van Bortel, RH Vander Stichele
Ageing research reviews, 2012•ElsevierBACKGROUND: Within the treatment of dementia, management of behavioural and
psychological symptoms (BPSD) is a complex component. PURPOSE: We wanted to offer a
pragmatic synthesis of existing specific practice recommendations for managing BPSD,
based on agreement among systematically appraised dementia guidelines. DATA
SOURCES: We conducted a systematic search in MEDLINE and guideline organisation
databases, supplemented by a hand search of web sites. STUDY SELECTION: Fifteen …
psychological symptoms (BPSD) is a complex component. PURPOSE: We wanted to offer a
pragmatic synthesis of existing specific practice recommendations for managing BPSD,
based on agreement among systematically appraised dementia guidelines. DATA
SOURCES: We conducted a systematic search in MEDLINE and guideline organisation
databases, supplemented by a hand search of web sites. STUDY SELECTION: Fifteen …
BACKGROUND
Within the treatment of dementia, management of behavioural and psychological symptoms (BPSD) is a complex component.
PURPOSE
We wanted to offer a pragmatic synthesis of existing specific practice recommendations for managing BPSD, based on agreement among systematically appraised dementia guidelines.
DATA SOURCES
We conducted a systematic search in MEDLINE and guideline organisation databases, supplemented by a hand search of web sites.
STUDY SELECTION
Fifteen retrieved guidelines were eligible for quality appraisal by the Appraisal of Guidelines Research and Evaluation instrument (AGREE), performed by 2 independent reviewers.
DATA EXTRACTION
From the 5 included guidelines, 18 specific practice recommendations for BPSD were extracted and compared for their level of evidence and strength.
DATA SYNTHESIS
No agreement was found among dementia guidelines for the majority of specific practice recommendations with regard to non-pharmacological interventions, although these were recommended as first-line treatment. Pharmacological specific practice recommendations were proposed as second-line treatment, with agreement for the use of a selection of antipsychotics based on strong supporting evidence, but with guidance for timely discontinuation.
LIMITATIONS
The appraisal of the level of agreement between guidelines for each specific practice recommendation was complicated by variation in grading systems, and was performed with criteria developed a posteriori.
CONCLUSION
Despite the limited number of recommendations for which agreement was found, guidelines did agree on careful antipsychotic use for BPSD. Adverse events might outweigh the supporting evidence of efficacy, weakening the recommendation. More pivotal trials on the effectiveness of non-pharmacological interventions, as well as guidelines specifically focusing on BPSD, are needed.
Elsevier
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