The efficacy of licensed-indication use of donepezil and memantine monotherapies for treating behavioural and psychological symptoms of dementia in patients with Alzheimer's disease: systematic review and meta-analysis

Dement Geriatr Cogn Dis Extra. 2011 Jan;1(1):212-27. doi: 10.1159/000330032. Epub 2011 Jul 20.


Background/aims: Behavioural and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD) greatly increase caregiver burden. The abilities of donepezil and memantine to manage BPSD within their licensed indications in AD were compared.

Methods: A systematic review, random effects meta-analysis and Bucher indirect comparison were conducted.

Results: Six randomised controlled studies (4 donepezil and 2 memantine) reported use within the licensed indication and had Neuropsychiatric Inventory (NPI) data suitable for meta-analysis. BPSD showed significant improvement with donepezil compared with placebo [weighted mean difference (WMD) in NPI -3.51, 95% confidence interval (CI) -5.75, -1.27], whereas this was not the case for memantine (WMD -1.65, 95% CI -4.78, 1.49). WMD in NPI for donepezil versus memantine favoured donepezil but was not statistically significant (-1.86, 95% CI -5.71, 1.99; p = 0.34).

Conclusion: Within its licensed indication, donepezil is efficacious for the management of BPSD in AD compared with placebo.

Keywords: Alzheimer disease; Behavioural medicine; Behavioural/psychiatric symptoms of dementia; Community Mental Health Services; Geriatric psychiatry; Home nursing; Meta-analysis; Preventive psychiatry; Systematic reviews.