Antipsychotics Increase Death Risk in Alzheimer's Patients
Alzheimer's patients who are prescribed antipsychotic drugs face a higher risk of death than similar patients
not given these medications do, British researchers report.
While the short-term use of antipsychotics has been found to benefit Alzheimer's patients, studies have
found that prolonged use can have serious side effects, including Parkinson-like symptoms, sedation,
chest infections, decline in brain function, stroke and death.
It's an eye-opening study since it was one of the few non-company sponsored studies to look at long-term risks.
Antipsychotics are not and never were indicated for use in people with dementia, but millions of elderly people have
been put on antipsychotics in nursing homes, often with little or no evidence to support such use.
For the study, the researchers randomly assigned 128 Alzheimer's patients to one of several antipsychotics or a placebo.
The antipsychotic drugs included thioridazine, chlorpromazine, haloperidol, trifluorperazine or risperidone.
The researchers found that, for the whole study period, the risk of death was 42 percent lower among people
taking a placebo compared with those taking antipsychotics.
After one year of follow-up, 70 percent of the patients taking antipsychotics were still living, compared
with 77 percent of those on placebo.
But after two years, 46 percent of those taking antipsychotics were alive, compared with 71 percent of those
taking placebo. After three years, only 30 percent of those on antipsychotics were alive, compared with 59 percent of those taking a placebo, the researchers found.
Despite the findings, there may still a place for antipsychotics in some people with dementia.
If there is no other way to stop an Alzheimer's patient from acting dangerously and all other measures
have failed, then antipsychotics can be used as a measure of last resort, but only for the shortest
possible time at the lowest possible dose.
The study authors found that there is still an important but limited place for atypical
antipsychotics in the treatment of severe neuropsychiatric manifestations of Alzheimer's disease, particularly
aggression. However, the accumulating safety concerns, including the substantial
increase in long-term mortality, emphasize the urgent need to put an end to unnecessary and prolonged prescribing.
Some experts believe that non-pharmacological treatments may be as effective as the antipsychotic drugs and
should be considered first. Non-pharmacological treatments are things like changing the environment of the patient,
changing the way the patient is addressed, and eliminating certain triggering events that
may cause deteriorations in patient behavior.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
Doraiswamy, P. M., & Thies, W. (2009). Alzheimer's Association; Jan. 8, 2009. The Lancet Neurology Online.
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