The effectiveness of quetiapine in improving behavioural and psychological symptoms in older adults with dementia

Abstract

Overview of the topic: Dementia is a syndrome that leads to progressive deterioration of cognitive functions. Behavioural and psychological symptoms can occur in up to 90% of patients. The use of antipsychotics especially off-label ones has been questioned regarding their efficacy in treating symptoms in elderly patients with dementia due to the potential risks of adverse effects and sudden death. The research question: Does Quetiapine improve the behavioural and psychological symptoms in older adults suffering from dementia? PICO elements: The population (P) is older adults suffering from dementia. The intervention (I) is Quetiapine. The comparison (C) was Placebo. The outcome (O) was reduced behavioural and psychological symptoms. Method: A systematic literature search was conducted using multiple online databases. Key elements from the PICO question were used as keywords to generate alternative words. They were combined using ‘Boolean Operators’. Limiters were applied to filter results. The PRISMA 2009 checklist was used to summarize the results of the literature search. The CASP tool was utilised to critically appraise the literature. Ethical issues were taken into consideration throughout this review. Inclusion and exclusion criteria: Inclusion criteria – Type of studies included were systematic reviews, meta-analysis, randomised controlled trials, open studies, and descriptive studies. Studies published between 2004 and 2020. Studies focusing on adults at the age of 55+, any type of dementia, and Quetiapine. Studies which measured behavioural and psychological symptoms. Exclusion Criteria - Studies investigating other antipsychotics which are not Quetiapine and non-English language studies. Main results: Five studies were identified. These included one meta-analysis, two randomised controlled trials, one open study and one descriptive study. Four out of five had positive effects on dementia symptoms. However, the shortcomings of the studies indicate the Quetiapine is not recommended. Conclusion: Quetiapine should be used with caution by monitoring the patient and used only for short periods of time. It should not be used as first line treatment but only after other antipsychotics have proved to be beneficial. Implications and Recommendations: Further education and training should be given to nurses and health care professionals regarding the side effects, adverse effects and mortality rate. Further protocols are needed to help guide professionals with decision making, including clear instructions of when to reduce dosage or stop the medication. Further recommendations regarding the use of non-pharmacological approaches should be enhanced as the first line strategy.