Pharmacological Therapy for Apathy in Alzheimer's Disease: A Systematic Review and Meta-Analysis

Can J Neurol Sci. 2017 May;44(3):267-275. doi: 10.1017/cjn.2016.426. Epub 2017 Feb 2.

Abstract

Introduction: Apathy is highly prevalent in Alzheimer's disease (AD), but whether pharmacotherapy is effective in managing apathy is unclear.

Methods: To assess the efficacy of pharmacotherapy for apathy in AD we searched for randomized controlled trials (RCT) and aggregate data reporting on apathy in several search engines, reference lists of articles, and reviews. Demographic characteristics and relevant data were extracted to assess apathy.

Results: Fifteen RCTs' were examined, and 11 were used in aggregate meta-analytic statistics. Drugs included were cholinesterase inhibitors, memantine, and psycho-stimulants. We found no significant treatment effect in favour of any of the drugs, and the effect-size estimates under a random effect model were heterogeneous. Most RCTs had a high attrition rate and used the NPI apathy subscale to measure apathy.

Conclusion: The lack of an effect could be explained by methodological limitations, publication bias, and heterogeneity.

Keywords: Alzheimer’s disease; Apathy; Clinical trials; Pharmacological treatment; Review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Alzheimer Disease / drug therapy*
  • Alzheimer Disease / psychology*
  • Apathy / drug effects*
  • Apathy / physiology
  • Central Nervous System Stimulants / pharmacology
  • Central Nervous System Stimulants / therapeutic use*
  • Cholinesterase Inhibitors / pharmacology
  • Cholinesterase Inhibitors / therapeutic use*
  • Clinical Trials as Topic / methods
  • Excitatory Amino Acid Antagonists / pharmacology
  • Excitatory Amino Acid Antagonists / therapeutic use
  • Humans
  • Memantine / pharmacology
  • Memantine / therapeutic use*

Substances

  • Central Nervous System Stimulants
  • Cholinesterase Inhibitors
  • Excitatory Amino Acid Antagonists
  • Memantine