机构:[1]Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China首都医科大学宣武医院[2]Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China神经科系统神经内科首都医科大学宣武医院[3]Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China[4]School of Biological Science and Medical Engineering, Beihang University, Beijing, China[5]Department of Cooperation of Chinese and Western Medicine Institute, Changchun University of Traditional Chinese Medicine, Changchun, China[6]Beijing Geriatric Hospital, Beijing, China
Background: High-quality clinical practice guidelines (CPGs) are important for the effective treatment of behavioral and psychological symptoms of dementia (BPSD). However, recommendations provided by different quality guidelines may lead to varied clinical practice outcomes. Objective: To assess the quality of available CPGs for the management of BPSD and summarize the best recommendations for treating BPSD. Methods: This was a systematic review of CPGs for the management of BPSD with data obtained from electronic databases and evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument, consisting of six domains: "Scope and purpose ", "Stakeholder involvement ", "Rigor of development ", "Clarity of presentation ", "Applicability ", and "Editorial independence ". The criteria for high-quality guidelines were set as: the score of high-quality guidelines in the "Rigor of development " domain should be >= 60% and as well as a score of > 60% in at least three other domains. High-quality guidelines were selected for recommendation extraction, and the final recommendations were formed in combination with the latest meta-analysis and randomized clinical-trial results. Results: In term of median scores in each domain for the six included CPGs, "Scope and purpose " (87.5%) scored better than all others, whereas "Applicability " (46.5%) was the domain with the lowest score. Four CPGs (2015 APA, 2018 NICE, 2018 CANADA, 2020 EAN) met the criteria of high-quality guidelines and were used to extract recommendations. From these four CPGs, nine specific recommendations related to the management of BPSD were summarized, of which seven were related to pharmacological treatment and two to non-pharmacological treatment. These recommendations covered the applicability of antipsychotic drugs, medication recommendations, withdrawal times, and several suitable non-pharmacological therapies. Conclusion: The quality of CPGs for the management of BPSD requires improvement, especially for the "Applicability " domain. For psychotic-like symptoms in dementia, the use of antipsychotics should be based on the individual's risk-benefit ratio, and the use of atypical antipsychotics seems to be a better choice. Non-pharmacological treatments may be suitable for emotional symptoms and sleep disorders.
基金:
National Key R&D Program of China [2017YFC1310103]; Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support [ZYLX201837]
第一作者机构:[1]Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China[2]Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China[3]Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
共同第一作者:
通讯作者:
通讯机构:[1]Innovation Center for Neurological Disorders, Xuan Wu Hospital, Capital Medical University, Beijing, China[2]Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China
推荐引用方式(GB/T 7714):
Ma Huixuan,Lu Xinliang,Zhou Aihong,et al.Clinical Practice Guidelines for the Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review With AGREE II[J].FRONTIERS IN NEUROLOGY.2022,13:doi:10.3389/fneur.2022.799723.
APA:
Ma, Huixuan,Lu, Xinliang,Zhou, Aihong,Wang, Fen,Zuo, Xiumei...&Wei, Cuibai.(2022).Clinical Practice Guidelines for the Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review With AGREE II.FRONTIERS IN NEUROLOGY,13,
MLA:
Ma, Huixuan,et al."Clinical Practice Guidelines for the Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review With AGREE II".FRONTIERS IN NEUROLOGY 13.(2022)