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Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults aged 65 years and older with dementia

Ellen Van Leeuwen (UGent) , Mirko Petrovic (UGent) , Marie van Driel (UGent) , An De Sutter (UGent) , Robert Vander Stichele (UGent) , Tom Declercq (UGent) and Thierry Christiaens (UGent)
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Organization
Abstract
Background: Antipsychotic drugs are often used to treat behavioral and psychological symptoms (BPSD) in adults aged 65 years and older with dementia, although there is uncertainty about the effectiveness of long-term use for this indication and there are concerns that they may cause harm. Objectives: To evaluate whether discontinuation of long-term antipsychotic drugs for BPSD is successful in adults aged 65 years and older with dementia. This article is based on a Cochrane review updated in 2018. Design: A Cochrane systematic review and meta-analysis. Setting and Participants: Eight databases were searched in January 2018 to identify 10 randomized controlled trials with 632 older adults. Measures: We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the number of patients completing the study. We considered sustained withdrawal of antipsychotics until the end of the study period as successful outcome. Results: Based on assessment of 7 studies (n ¼ 446), discontinuation may make little or no difference to whether or not participants complete the study (low-quality evidence). In 2 trials, including participants with psychosis, agitation, or aggression who had responded to antipsychotic treatment, discontinuation of antipsychotics was associated with a higher risk of leaving the study prematurely because of symptomatic relapse or a shorter time to symptomatic relapse. We found low-quality evidence from 7 trials (n ¼ 519) that discontinuation may make little or no difference to overall BPSD, measured using various scales. There was some evidence from subgroup analyses in 2 trials that discontinuation may be associated with a worsening of BPSD in participants with more severe BPSD at baseline. Conclusions: Our meta-analysis revealed that there is low-quality evidence that long-term antipsychotic drugs for BPSD may be successfully discontinued in most adults aged 65 and older.
Keywords
antipsychotics, dementia, behavioral and psychological symptoms, discontinuation, DOUBLE-BLIND, NURSING-HOME, WITHDRAWAL, THIORIDAZINE

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MLA
Van Leeuwen, Ellen, Mirko Petrovic, Marie van Driel, et al. “Discontinuation of Long-term Antipsychotic Drug Use for Behavioral and Psychological Symptoms in Older Adults Aged 65 Years and Older with Dementia.” JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 19.11 (2018): 1009–1014. Print.
APA
Van Leeuwen, Ellen, Petrovic, M., van Driel, M., De Sutter, A., Vander Stichele, R., Declercq, T., & Christiaens, T. (2018). Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults aged 65 years and older with dementia. JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, 19(11), 1009–1014.
Chicago author-date
Van Leeuwen, Ellen, Mirko Petrovic, Marie van Driel, An De Sutter, Robert Vander Stichele, Tom Declercq, and Thierry Christiaens. 2018. “Discontinuation of Long-term Antipsychotic Drug Use for Behavioral and Psychological Symptoms in Older Adults Aged 65 Years and Older with Dementia.” Journal of the American Medical Directors Association 19 (11): 1009–1014.
Chicago author-date (all authors)
Van Leeuwen, Ellen, Mirko Petrovic, Marie van Driel, An De Sutter, Robert Vander Stichele, Tom Declercq, and Thierry Christiaens. 2018. “Discontinuation of Long-term Antipsychotic Drug Use for Behavioral and Psychological Symptoms in Older Adults Aged 65 Years and Older with Dementia.” Journal of the American Medical Directors Association 19 (11): 1009–1014.
Vancouver
1.
Van Leeuwen E, Petrovic M, van Driel M, De Sutter A, Vander Stichele R, Declercq T, et al. Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults aged 65 years and older with dementia. JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION. 2018;19(11):1009–14.
IEEE
[1]
E. Van Leeuwen et al., “Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults aged 65 years and older with dementia,” JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, vol. 19, no. 11, pp. 1009–1014, 2018.
@article{8570686,
  abstract     = {Background: Antipsychotic drugs are often used to treat behavioral and psychological symptoms (BPSD) in adults aged 65 years and older with dementia, although there is uncertainty about the effectiveness of long-term use for this indication and there are concerns that they may cause harm.
Objectives: To evaluate whether discontinuation of long-term antipsychotic drugs for BPSD is successful in adults aged 65 years and older with dementia. This article is based on a Cochrane review updated in 2018.
Design: A Cochrane systematic review and meta-analysis.
Setting and Participants: Eight databases were searched in January 2018 to identify 10 randomized controlled trials with 632 older adults.
Measures: We used standard methodological procedures according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed the number of patients completing the study. We considered sustained withdrawal of antipsychotics until the end of the study period as successful outcome.
Results: Based on assessment of 7 studies (n ¼ 446), discontinuation may make little or no difference to whether or not participants complete the study (low-quality evidence). In 2 trials, including participants with psychosis, agitation, or aggression who had responded to antipsychotic treatment, discontinuation of antipsychotics was associated with a higher risk of leaving the study prematurely because of symptomatic relapse or a shorter time to symptomatic relapse. We found low-quality evidence from 7 trials (n ¼ 519) that discontinuation may make little or no difference to overall BPSD, measured using various scales. There was some evidence from subgroup analyses in 2 trials that discontinuation may be associated with a worsening of BPSD in participants with more severe BPSD at
baseline.
Conclusions: Our meta-analysis revealed that there is low-quality evidence that long-term antipsychotic drugs for BPSD may be successfully discontinued in most adults aged 65 and older.},
  author       = {Van Leeuwen, Ellen and Petrovic, Mirko and van Driel, Marie and De Sutter, An and Vander Stichele, Robert and Declercq, Tom and Christiaens, Thierry},
  issn         = {1525-8610},
  journal      = {JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION},
  keywords     = {antipsychotics,dementia,behavioral and psychological symptoms,discontinuation,DOUBLE-BLIND,NURSING-HOME,WITHDRAWAL,THIORIDAZINE},
  language     = {eng},
  number       = {11},
  pages        = {1009--1014},
  title        = {Discontinuation of long-term antipsychotic drug use for behavioral and psychological symptoms in older adults aged 65 years and older with dementia},
  url          = {http://dx.doi.org/10.1016/j.jamda.2018.06.023},
  volume       = {19},
  year         = {2018},
}

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