Meta-Analysis: Do Cholinesterase Inhibitors Improve Psychotic Symptoms in Patients with Neurodegenerative Disorders?
BACKGROUND AND PURPOSE:
- d’Angremont et al. (JAMA Neurology, 2023) assessed the use of cholinesterase inhibitors (ChEIs) for treatment of individual neuropsychiatric symptoms in patients Alzheimer disease (AD), Parkinson disease (PD), and dementia with Lewy bodies (DLB)
METHODS:
- Systematic review and meta-analysis
- Study inclusion criteria
- Randomized controlled trials
- Studies that including at least 1 donepezil, rivastigmine, or galantamine treatment arm in patients with AD, PD, or DLB, compared to placebo, and measured at least one neuropsychiatric symptom, such as hallucinations and/or delusions
- Study design
- A 2-stage meta-analysis was performed using random-effects models
- First stage: Data is collected from each study separately and analyzed individually
- Second stage: The summarized or aggregated data from each study is combined to perform a meta-analysis
- A 2-stage meta-analysis was performed using random-effects models
- Primary outcomes
- Hallucinations and delusions
- Secondary outcomes
- All other individual neuropsychiatric subdomains
- The total neuropsychiatric score
RESULTS:
- 17 RCTs | 6649 individuals
- Women: 62.6% | Mean age: 75.0 (SD, 8.2) years
- AD: 12 | PS: 5
- ChEI treatment was associated with a reduction in delusions and hallucinations
- Delusions
- AD: SMD −0.08 (95% CI, −0.14 to −0.03) | P=0.006
- PD: SMD −0.14 (95% CI, −0.26 to −0.01) | P=0.04
- Hallucinations
- AD: SMD −0.09 (95% CI, −0.14 to −0.04) | P=0.003
- PD: SMD −0.08 (95% CI, −0.13 to −0.03) | P=0.01
- Delusions
CONCLUSION:
- ChEI treatment improves hallucinations and delusions in patients with neurodegenerative disease, but effect sizes are small
- The authors state
Psychotic symptoms appear to significantly increase the disease burden for patients and caregivers, and alternative treatment with, for instance, antipsychotic medication has been associated with serious adverse effects
Therefore, our data may provide an extra reason to consider ChEI treatment as a first-line pharmacotherapy for psychotic symptoms in people with AD and PD
Learn More – Primary Sources:
SPECIALTY AREAS
- Alerts
- Allergy And Immunology
- Cancer Screening
- Cardiology
- Dermatology
- Diabetes
- Endocrine
- ENT
- Evidence Matters
- General Internal Medicine
- Genetics
- GI
- GU
- Hematology
- ID
- Medical Legal
- Mental Health
- MSK
- Nephrology
- Neurology
- Now@PcMED
- Oncology
- PcMED Connect
- PrEP Resource Center
- Preventive Medicine
- Pulmonary
- Rheumatology
- Test Your Knowledge
- Vaccinations
- Women's Health
- Your Practice