Table_1_Clinical Practice Guidelines for the Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review With AGREE II.DOCX

BackgroundHigh-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.
ObjectiveTo assess the quality of available CPGs for the management of BPSD and summarize the best recommendations for treating BPSD.
MethodsThis 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.
ResultsIn 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.
ConclusionThe 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.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209204.

背景：高质量临床实践指南（Clinical Practice Guidelines, CPGs）对于痴呆行为和精神症状（Behavioral and Psychological Symptoms of Dementia, BPSD）的有效干预至关重要。然而，不同质量等级指南所提出的推荐意见，可能会导致临床实践结局存在差异。
研究目的：评估现有用于痴呆行为和精神症状管理的临床实践指南的质量，并总结针对该病症的最优推荐意见。
研究方法：本研究为针对痴呆行为和精神症状管理相关临床实践指南的系统评价，数据来源于电子数据库，并采用指南研究与评价工具II（Appraisal of Guidelines for Research and Evaluation II, AGREE II）进行质量评价，该工具包含6个评价领域：“范围与目的”、“利益相关方参与”、“制定严谨性”、“表述清晰度”、“适用性”以及“编辑独立性”。高质量指南的判定标准设定为：在“制定严谨性”领域的得分≥60%，且在至少其余3个领域的得分>60%。筛选符合标准的高质量指南用于提取推荐意见，并结合最新的荟萃分析与随机对照试验结果，形成最终推荐意见。
研究结果：纳入的6篇临床实践指南在各领域的中位得分显示，“范围与目的”领域得分最高（87.5%），而“适用性”领域得分最低（46.5%）。共有4篇指南（2015年美国精神病学协会[American Psychiatric Association, APA]指南、2018年英国国家卫生与临床优化研究所[National Institute for Health and Care Excellence, NICE]指南、2018年加拿大指南、2020年欧洲神经病学学会[European Academy of Neurology, EAN]指南）符合高质量指南标准，被用于提取推荐意见。从这4篇指南中，共总结出9项与痴呆行为和精神症状管理相关的具体推荐意见，其中7项涉及药物治疗，2项涉及非药物治疗。这些推荐意见涵盖了抗精神病药物的适用性、用药建议、停药时机，以及数种适宜的非药物治疗手段。
结论：用于痴呆行为和精神症状管理的临床实践指南质量仍有待提升，尤其是“适用性”领域。针对痴呆患者的精神病性症状，抗精神病药物的使用应基于个体的风险获益比，而非典型抗精神病药物似乎是更优选择。非药物治疗或可适用于情绪症状与睡眠障碍的干预。
系统评价注册信息：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209204