Abstract
Background: We conducted a systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials of anti-dementia drugs plus antipsychotics for schizophrenia. Methods: Primary outcomes of efficacy and safety included improving overall symptoms (Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores) and all-cause discontinuation, respectively. Other outcomes included psychopathology subscales (positive, negative, general, and anxiety/depressive symptoms), cognitive function (attention/ vigilance, reasoning/problem solving, social cognition, speed of processing, verbal learning, visual learning, working memory, and cognitive control/executive function), Mini-Mental State Examination scores, treatment discontinuation due to adverse events and inefficacy, and individual adverse events. We evaluated the effect size using a random effects model. Results: We identified 37 studies (n=1574): 14 donepezil-based (n=568), 10 galantamine-based (n=371), 4 rivastigmine-based (n=146), and 9 memantine-based (n=489) studies. Pooled anti-dementia drugs plus antipsychotics treatments were superior to placebo plus antipsychotics in improving the overall symptoms (24 studies, 1069 patients: standardized mean difference=−0.34, 95% CI=−0.61 to −0.08, P=.01), negative symptoms (24 studies, 1077 patients: standardized mean difference =−0.62, 95% CI=−0.92 to −0.32, Pcorrected=.00018), and Mini-Mental State Examination scores (7 studies, 225 patients: standardized mean difference=−0.79, 95% CI=−1.23 to −0.34, P=.0006). No significant differences were found between antidementia drugs plus antipsychotics and placebo plus antipsychotics regarding other outcomes. Conclusions: Although the results suggest that anti-dementia drugs plus antipsychotics treatment improves negative symptoms and Mini-Mental State Examination scores in schizophrenia patients, they possibly were influenced by a small-study effect and some bias. However, it was not superior to placebo plus antipsychotics in improving composite cognitive test score, which more systematically evaluates cognitive impairment than the Mini-Mental State Examination score. Overall, the anti-dementia drugs plus antipsychotics treatment was well tolerated.
| Original language | English |
|---|---|
| Pages (from-to) | 748-757 |
| Number of pages | 10 |
| Journal | International Journal of Neuropsychopharmacology |
| Volume | 21 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 01-01-2018 |
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All Science Journal Classification (ASJC) codes
- Pharmacology
- Psychiatry and Mental health
- Pharmacology (medical)
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Anti-dementia drugs for psychopathology and cognitive impairment in schizophrenia : A systematic review and meta-analysis. / Kishi, Taro; Ikuta, Toshikazu; Oya, Kazuto; Matsunaga, Shinji; Matsuda, Yuki; Iwata, Nakao.
In: International Journal of Neuropsychopharmacology, Vol. 21, No. 8, 01.01.2018, p. 748-757.Research output: Contribution to journal › Review article
TY - JOUR
T1 - Anti-dementia drugs for psychopathology and cognitive impairment in schizophrenia
T2 - A systematic review and meta-analysis
AU - Kishi, Taro
AU - Ikuta, Toshikazu
AU - Oya, Kazuto
AU - Matsunaga, Shinji
AU - Matsuda, Yuki
AU - Iwata, Nakao
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background: We conducted a systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials of anti-dementia drugs plus antipsychotics for schizophrenia. Methods: Primary outcomes of efficacy and safety included improving overall symptoms (Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores) and all-cause discontinuation, respectively. Other outcomes included psychopathology subscales (positive, negative, general, and anxiety/depressive symptoms), cognitive function (attention/ vigilance, reasoning/problem solving, social cognition, speed of processing, verbal learning, visual learning, working memory, and cognitive control/executive function), Mini-Mental State Examination scores, treatment discontinuation due to adverse events and inefficacy, and individual adverse events. We evaluated the effect size using a random effects model. Results: We identified 37 studies (n=1574): 14 donepezil-based (n=568), 10 galantamine-based (n=371), 4 rivastigmine-based (n=146), and 9 memantine-based (n=489) studies. Pooled anti-dementia drugs plus antipsychotics treatments were superior to placebo plus antipsychotics in improving the overall symptoms (24 studies, 1069 patients: standardized mean difference=−0.34, 95% CI=−0.61 to −0.08, P=.01), negative symptoms (24 studies, 1077 patients: standardized mean difference =−0.62, 95% CI=−0.92 to −0.32, Pcorrected=.00018), and Mini-Mental State Examination scores (7 studies, 225 patients: standardized mean difference=−0.79, 95% CI=−1.23 to −0.34, P=.0006). No significant differences were found between antidementia drugs plus antipsychotics and placebo plus antipsychotics regarding other outcomes. Conclusions: Although the results suggest that anti-dementia drugs plus antipsychotics treatment improves negative symptoms and Mini-Mental State Examination scores in schizophrenia patients, they possibly were influenced by a small-study effect and some bias. However, it was not superior to placebo plus antipsychotics in improving composite cognitive test score, which more systematically evaluates cognitive impairment than the Mini-Mental State Examination score. Overall, the anti-dementia drugs plus antipsychotics treatment was well tolerated.
AB - Background: We conducted a systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials of anti-dementia drugs plus antipsychotics for schizophrenia. Methods: Primary outcomes of efficacy and safety included improving overall symptoms (Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores) and all-cause discontinuation, respectively. Other outcomes included psychopathology subscales (positive, negative, general, and anxiety/depressive symptoms), cognitive function (attention/ vigilance, reasoning/problem solving, social cognition, speed of processing, verbal learning, visual learning, working memory, and cognitive control/executive function), Mini-Mental State Examination scores, treatment discontinuation due to adverse events and inefficacy, and individual adverse events. We evaluated the effect size using a random effects model. Results: We identified 37 studies (n=1574): 14 donepezil-based (n=568), 10 galantamine-based (n=371), 4 rivastigmine-based (n=146), and 9 memantine-based (n=489) studies. Pooled anti-dementia drugs plus antipsychotics treatments were superior to placebo plus antipsychotics in improving the overall symptoms (24 studies, 1069 patients: standardized mean difference=−0.34, 95% CI=−0.61 to −0.08, P=.01), negative symptoms (24 studies, 1077 patients: standardized mean difference =−0.62, 95% CI=−0.92 to −0.32, Pcorrected=.00018), and Mini-Mental State Examination scores (7 studies, 225 patients: standardized mean difference=−0.79, 95% CI=−1.23 to −0.34, P=.0006). No significant differences were found between antidementia drugs plus antipsychotics and placebo plus antipsychotics regarding other outcomes. Conclusions: Although the results suggest that anti-dementia drugs plus antipsychotics treatment improves negative symptoms and Mini-Mental State Examination scores in schizophrenia patients, they possibly were influenced by a small-study effect and some bias. However, it was not superior to placebo plus antipsychotics in improving composite cognitive test score, which more systematically evaluates cognitive impairment than the Mini-Mental State Examination score. Overall, the anti-dementia drugs plus antipsychotics treatment was well tolerated.
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U2 - 10.1093/ijnp/pyy045
DO - 10.1093/ijnp/pyy045
M3 - Review article
VL - 21
SP - 748
EP - 757
JO - International Journal of Neuropsychopharmacology
JF - International Journal of Neuropsychopharmacology
SN - 1461-1457
IS - 8
ER -