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Journal Presentation: Supervisor: Dr. Sabar P. Siregar, SP - KJ
Journal Presentation: Supervisor: Dr. Sabar P. Siregar, SP - KJ
PRESENTATION
Supervisor : dr. Sabar P.
Siregar, Sp.KJ
2
BACKGROUNDS
Use of antipsychotics to treat behavioural symptoms of dementia
has been associated with increased risks of mortality and stroke.
Aims
We examined the risperidone clinical trial data with these adverse
outcomes
METHODS
Double-blind randomised controlled trial of risperidone in dementia
patients (Risperidone n=1009 V Placebo n=712)
Analysed Crude Insidences
Cox Proportional Hazards Regression
BACKGROUND
Risperidone Persistent aggression in patients with moderate to
severe alzheimers with moderate to severe alzheimers dementia
unresponsive to non-pharmacological approachs
Identifying patients characteristics and treatment emergent events
stroke and death risperidone and placebo
METHODS
Included men and womeb aged 55 years / over with Alzheimers
vascular or mixed dementia
In our analysis all risperidone doses were combined into a single
group
VARIABLES
Age ( < 80 years V 80 years)
Gender, ethnicity, diagnosis, BMI, MMSE
Statistical Analysis
SAS Version 9.2
Fishers exact test was used to compared the crude incidences of
CVAE and mortality
RESULTS
There was statistically significant different in the crude incidence of
all CVAE across all studies
Risperidone; 4,9% V Placebo; 1,5% (p<0,001)
Role of chance
Random error can be caused by :
Patients medication adherence
Rate of medication changes
WHAT WERE THE RESULTS
OF THIS RESEARCHES ?
Baseline complications of depression (treatment by
risk factor interaction on cerebrovascular adverse
event (CVAE) hazard ratio (HR): P = 0.025) and
delusions (P = 0.043) were associated with a lower
relative risk of CVAE in risperidonetreated patients
(HR = 1.47 and 0.54, respectively) compared to not
having the complication (HR = 5.88 and 4.16). For
mortality, the only significant baseline predictor in
patients treated with risperidone was depression,
which was associated with a lower relative risk
HOW PRECISE THE RESULTS
OF THE STUDY ?
It was not really precise because it did not consider
the combination of the drug and drug dose. This
study did not explain the reasons to categorizing the
patients who taking typical and atypical
antipsychotic to the typical antipsychotic
Risk factors for stroke and death in people with
dementia treated with an atypical antipsychotic not
analysed
Then this study have not explained precisely on
WAS THE RESULTS CAN BE
TRUSTED ?
The results can be trusted
WAS THE RESULTS CAN BE
APPLIED IN THE LOCAL
CONTEXT ?
Can not be, because this study used
a sample of 100% from Europe, in
this case the races and culture can
affect the differences in drug dosage
and social environment
WERE THE RESULTS
CONVENIENT ACCORDING
TO THE PREVIUS SCIENTIFIC
EVIDENCE ?
Clinicians will continue to consider antipsychotic
short-term treatment for behavioural and
psychiatric symptoms in dementia when those
symptoms cause significant distress or carry risk
of harm to the patient or others, and when
alternative, nonpharmacological interventions
are unavailable or have failed