Anti-Dementia Drugs for Psychopathology and Cognitive Impairment in Schizophrenia: A Systematic Review and Meta-Analysis

Results

We identified 37 studies (n=1574): 14 donepezil-based (n=568), 10 galantamine-based (n=371), 4 rivastigmine-based (n=146), and 9 memantine-based (n=489) studies. Pooled anti-dementia drugs plus antipsychotics treatments were superior to placebo plus antipsychotics in improving the overall symptoms (24 studies, 1069 patients: standardized mean difference = −0.34, 95% CI = −0.61 to −0.08, P= .01), negative symptoms (24 studies, 1077 patients: standardized mean difference = −0.62, 95% CI = −0.92 to −0.32, P corrected = .00018), and Mini-Mental State Examination scores (7 studies, 225 patients: standardized mean difference = −0.79, 95% CI = −1.23 to −0.34, P= .0006). No significant differences were found between anti-dementia drugs plus antipsychotics and placebo plus antipsychotics regarding other outcomes.

Conclusions

Although the results suggest that anti-dementia drugs plus antipsychotics treatment improves negative symptoms and Mini-Mental State Examination scores in schizophrenia patients, they possibly were influenced by a small-study effect and some bias. However, it was not superior to placebo plus antipsychotics in improving composite cognitive test score, which more systematically evaluates cognitive impairment than the Mini-Mental State Examination score. Overall, the anti-dementia drugs plus antipsychotics treatment was well tolerated.

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To be fair though, anti-dementia drugs have only a small effect on dementia. So it’s probably not surprising that the effect with sz is also small.

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