[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 8, March 2012].
Some antipsychotic medications increase the risk of death in patients with dementia more than others, according to a US study published in the BMJ. Researchers from Harvard Medical School followed 75,445 dementia patients in nursing homes who had been prescribed antipsychotics. When compared with risperidone (the antipsychotic taken as a benchmark) some of the other drugs were associated with more than twice the risk of death.
The authors of this study concluded the risk of mortality from some antipsychotics increased with higher doses. The risk appeared to be highest for haloperidol and lowest for quetiapine (which reduced the risk). The effects were strongest shortly after the start of treatment. Quetiapine appears to be less of a danger than the other atypical antipsychotic drugs, but further research is required to confirm this.
Note: Reducing the level of antipsychotics prescribing for people with dementia by two-thirds is already a key national priority. The Dementia Action Alliance (which includes the Alzheimer’s Society, Age UK and the Department of Health) has earlier demanded that prescriptions for antipsychotics in the UK are reviewed by the end of March 2012, although actual progress is thought to be frustratingly slow.
These drugs should only be used for dealing with challenging behaviour in people with dementia after the alternatives have failed. More research is needed on the alternatives to antipsychotics for people with dementia and behavioural problems (BPSD). Similarly, further research is required into practical considerations like the best dosage and the ideal permissible duration of use for these drugs in more difficult situations such as violent behaviour or severe distress.
Gallagher, J. (2012). Antipsychotics death risk charted in dementia patients. London: BBC Health News, February 24th 2012.
Huybrechts, KF. Gerhard, T. [and] Crystal, S. [et al] (2012). Research: Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study. BMJ, February 23rd 2012; 344, e977.
In a related editorial, the issues are explored with an assertion that more research is required into non-drug interventions and service structures.
Full Text Link (c) (Access requires an Athens password or journal subscription).
McCleery, J. [and] Fox, R. (2012). Editorial: Antipsychotic prescribing in nursing homes. BMJ, February 23rd 2012; 344, e1093.