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

  • Amir A. Sepehry (a1), Michael Sarai (a2) and Ging-Yuek R. Hsiung (a1)

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.

Traitement pharmacologique de l’apathie liée à la maladie d’Alzheimer: revue systématique et méta-analyse. Introduction: L’apathie est un état très courant chez les patients atteints de la maladie d’Alzheimer. Cela dit, on ignore encore dans quelle mesure la pharmacothérapie permet de le traiter de façon efficace. Méthodes: Afin d’évaluer l’efficacité des traitements pharmacologiques de l’apathie liée à la maladie d’Alzheimer, nous avons effectué une recension d’essais cliniques randomisés (ECR) et rassemblé, au moyen de plusieurs moteurs de recherche, de listes de référence d’articles clés et de recensions, des données concernant cet état. Des caractéristiques démographiques et d’autres données jugées pertinentes ont ensuite été extraites afin de mieux l’évaluer. Résultats: Au total, nous avons passé en revue quinze ECR ; onze d’entre eux ont été utilisés dans le cadre d’une méta-analyse agrégée. Parmi les médicaments inclus, on peut mentionner les inhibiteurs de cholinestérase, la mémantine et un certain nombre de psychostimulants. En gros, nous n’avons relevé aucun effet notable associé à la prise de ces médicaments. De plus, les estimations de l’ampleur des effets en vertu d’un modèle à effets aléatoires se sont révélées hétérogènes. Fait à noter, la plupart des ECR ont dû composer avec un taux d’abandon élevé et ont utilisé le Neuropsychiatric Inventory (NPI) pour mesurer l’apathie. Conclusions: L’absence d’effet pourrait s’expliquer par des contraintes méthodologiques, des biais de publication et une hétérogénéité statistique.

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Corresponding author

Correspondence to: Ging-Yuek R. Hsiung, Division of Neurology, S152 – 2211 Wesbrook Mall, University of British Columbia, Vancouver BC, Canada V6T 2B5. Email: hsiung@mail.ubc.ca

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