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