A Systematic Review Of The Effectiveness And Safety Of Atypical Antipsychotic For Dementia

background : There are more and more dementia patients with the development of society,which has become a important social problem. Dementia causes unestimated healthcare costs per year.Neuropsychiatric symptoms have been suggested to impose the greatest burden on family caregivers.A variety of atypical antipsychotic drugs are widely used in the management of neuropsychiatric symptoms,which are commonly seen in dementia, but results on the effectiveness and safety of these agents are conflicting. We aimed to compare the efficacy and safety of olanzapine,risperidone and quetiapine drugs in patients with psychological and behavioral symptoms of dementia.Method:Systematically searched EMBASE,the Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews, Medline, CNKI, Wang Fang Data,Forest Laboratories before February 2016 for eligible randomized controlled trials of olanzapine, risperidone and quetiapine drugs therapy in patients with psychotic symptoms of dementia. Two reviewers independently assessed the quality of the trials and extracted information.All the data woulid be analysed with meta analysis and analysis software of the Revman5.3 Provided by Cochrane network.Result :Overall,18 relevant RCTs with 1788 participants were identified(olanzapine group:692; risperidone group:709; quetiapine group:387).This meta-an alysis demonstrated a significant efficacy of atypical antipsychotics on psychiatric symptoms.In the meta-analysis,the Standardized mean difference(SMD) in chang escores for psychiatric symptoms were no difference between olanzapine and risperidone(-0.01,95%CI [-0.14,0.13],P=0.91).SMD in change scores for psychiatric symptoms were no difference between quetiapine and risperidone(-0.13,95%CI [-0.14,0.13],P=0.91).SMD in change scores for psychiatric symptoms were no differe nce between olanzapine and quetiapine(0.20,95%CI [-0.32,0.73],P=0.45).In terms o f safety,olanzapine group was higher incidence than risperidone group in somnolence, while in the dizziness, extrapyramidal symptoms, abnormal gait, wea kness, agitation, accidental injury, weight gain, sleep disorders,there was no signif icant difference.(somnolence: OR=1.49,95%CI [-1.01,2.21],P=0.05).Risperidone was higherincidence than quetiapine group in extrapyramidal symptoms, the incidence of somnolence was lower than quetiapine group, while in fatigue, insomnia,accidental injury, dizziness, constipation, there was no significant difference(extrap yramidal symptoms:OR=0.11,95%CI [0.04,0.27],P=0.64; somnolence:OR=0.03,95%CI [1.06,3.51],P=0.03).Olanzapine group was higher incidence of extrapyramidal symptoms than quetiapine group, while in somnolence, weight gain, constipation,dizziness, sleep disturbances, agitation, there was no significant difference(extrapyramidal symptoms: OR=11.10,95%CI [3.35,36.75],P<0.0001). Subgroup ana lysis about securityshowed that the Chinese population compared with the popula tion in Europe and America, risperidone group was higer incidence of extrapyra midal symptoms, agitation, sleep disorders than olanzapine, olanzapine group was higer incidence of weight gain than quetiapine.Conclusion:There are no difference between olanzapine, risperidone and quetiapine to improve psychiatric symptoms in patients with neuropsychiatric symptoms of dementia.In terms of security, among olanzapine, risperidone, quetiapine, risperidone is lowest incidence of somnolence, quetiapine is lowest incidence of extrapyramidal symptoms.