The Wider Range of Adverse Outcomes Associated with Antipsychotics in Dementia Patients

The Wider Range of Adverse Outcomes Associated with Antipsychotics in Dementia Patients

The use of antipsychotics in dementia patients has been associated with an increased risk for a wider range of adverse outcomes than previously acknowledged. A population-based matched cohort study from the U.K. revealed that dementia patients prescribed antipsychotics were more than twice as likely to be diagnosed with pneumonia within 90 days compared to non-users. In addition to pneumonia, there were increases in the risk of acute kidney injury, venous thromboembolism, stroke, fracture, myocardial infarction, and heart failure among antipsychotic users.

The study analyzed data from over 170,000 adults with dementia, with researchers led by Pearl Mok, PhD, of Manchester Academic Health Science Center in England. The relative hazards were found to be highest in the first 7 days of antipsychotic use for nearly all outcomes. The risk of pneumonia, for example, was nearly 10 times higher in the initial period of antipsychotic treatment. These findings suggest a critical need to consider the risks of harm associated with antipsychotics before prescribing them to dementia patients.

Despite longstanding concerns about the safety of antipsychotics in dementia patients, these medications are still commonly prescribed to manage behavioral and psychological symptoms. The efficacy of antipsychotics for treating these symptoms is limited, and some antipsychotics, like risperidone, have black box warnings in the U.S. due to an increased risk of death when used to treat dementia-related psychosis. The study emphasizes the importance of taking into account the risk of harm and exploring non-drug alternatives for symptom management.

In an accompanying editorial, researchers from the University of Maryland School of Medicine highlighted the expanded scope of known risks associated with prescribing antipsychotics in dementia. They emphasized the need for healthcare professionals to carefully justify the use of antipsychotics in dementia care, considering a comprehensive assessment of benefits versus a broader range of serious harms than previously recognized. The findings of this study provide nuanced data to guide personalized treatment decisions for dementia patients.

The study was conducted by collecting data from electronic health records of dementia patients in the U.K. from 1998 to 2018. Most patients included in the study were women with a mean age of 82 years. While the study adjusted for a wide range of patient characteristics, it was limited by its observational approach and potential for residual confounders. The lack of effective nonpharmacological treatment alternatives for behavioral and psychological symptoms of dementia poses a challenge to reducing the use of antipsychotics.

The use of antipsychotics in dementia patients is associated with a wider range of adverse outcomes than previously acknowledged. Healthcare professionals should carefully weigh the risks of harm when considering prescribing antipsychotics and explore non-drug approaches whenever possible. The findings of this study provide valuable insights into the risks associated with antipsychotic use in dementia and underscore the need for personalized treatment decisions based on a comprehensive assessment of benefits and harms.

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