Regular Research Article
Systematic Review of the Effectiveness of Pharmacologic Interventions to Improve Quality of Life and Well-being in People With Dementia

https://doi.org/10.1016/j.jagp.2012.10.018Get rights and content

Objective

To review systematically, for the first time, the effectiveness of all pharmacologic interventions to improve quality of life and well-being in people with dementia.

Design

Systematic review and meta-analysis.

Methods

We systematically reviewed the 15 randomized controlled trials and one review that fitted predetermined criteria. We included studies that reported the outcomes quality of life, well-being, happiness, or pleasure.

Measurements

We rated the validity of studies using a checklist. We calculated mean differences between intervention and control groups at follow-up.

Results

None of the evaluated trials reported a significant benefit to quality of life or well-being for people with dementia when comparing those taking a drug or its comparator at follow-up (pooled weighted mean difference: 0.18 [95% confidence interval: −0.82 to 0.46]).

Conclusion

We found no consistent evidence that any drug improves quality of life in people with dementia. We recommend that all dementia trials should include quality of life as an outcome, as this is important to patients, and cannot be presumed from improvements in cognition or other symptomatic outcomes, especially if the latter are small.

Section snippets

Search Strategy

We searched PubMed, Web of Science, and the Cochrane Database of Systematic Reviews through January 2011. We used the keywords dementia or Alzheimer; QOL, well-being, happiness, life satisfaction, or pleasure; and treatment or intervention. We searched references of all included articles and relevant systematic review articles identified in our search. We contacted experts in the field and manufacturers of drugs licensed for the treatment of dementia to ask whether they knew of other articles

Results

Fifteen original research studies and one Cochrane review qualified for inclusion out of a total of 1,080 studies examined. Figure 2 gives details of the search strategy and results, and the reasons for excluding studies. We did not find evidence of significant publication bias in the 13 studies for which we could calculate this (Egger statistic: 0.07, 95% CI: –1.1 to 1.2; Figure 1). We report mean differences for 12 studies (Figure 3). The pooled WMD for these studies was −0.18 (95% CI: −0.82

Discussion

Our main finding is the lack of evidence that any pharmacologic intervention improved the QOL of people with dementia. This should be interpreted with caution, as many of the studies were small, whereas others did not use a valid QOL measure. Therefore, we cannot be confident about the absence of effects on QOL. We found no trials of galantamine or rivastigmine, both of which are licensed for use in AD, that included QOL as an outcome measure.

Two trials, one of G biloba 240 mg a day for people

Limitations

None of the studies reviewed demonstrated sufficient power to detect a difference in QOL, and many were probably underpowered to do so. Some studies asked the person with dementia about QOL, others asked family or professional carers, some asked both, and some observed it directly. People with dementia rate their own QOL more highly than carers rate it by proxy.32 Improving QOL is complex, as this is probably somewhat distal to improvements in cognition or neuropsychiatric symptoms. It is

Conclusions

We found no clear evidence that any pharmacologic intervention improved the QOL of people with dementia. In two trials, both lasting 24 weeks, there was suggestive evidence that G biloba 240 mg a day for people with vascular dementia or AD and testosterone gel for men with AD might be effective in improving QOL. We found only 15 RCTs measuring QOL, indicating that most RCTs in dementia to date have not included, or not reported, a QOL outcome. We recommend that all dementia trials should

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