Study shows antipsychotics increase health risk in dementia patients

Study shows antipsychotics increase health risk in dementia patients

In a current oneBritish Medical JournalIn the study, researchers assess the side effects associated with taking antipsychotics in people with dementia.

The role of antipsychotics in dementia treatment

Individuals diagnosed with dementia experience functional impairment and progressive cognitive decline. Common psychological and behavioral symptoms of dementia include anxiety, depression, apathy, aggression, delirium, irritability, and psychosis.

To manage the psychological and behavioral symptoms of dementia, patients are commonly treated with antipsychotics. The United Kingdom's National Institute for Health and Care Excellence currently recommends the use of antipsychotics only when non-drug interventions are ineffective in relieving behavioral and psychological symptoms of dementia. However, during the recent coronavirus disease 2019 (COVID-19) pandemic, there has been an increase in antipsychotic use due to lockdown measures and unavailability of non-pharmaceutical treatments.

In the UK, risperidone and haloperidol are the only antipsychotics approved for the treatment of behavioral or psychological symptoms of dementia. In 2003, the US Food and Drug Administration (FDA) highlighted the risks such as stroke, transient ischemic attack and mortality associated with the use of risperidone in older adults with dementia.

Based on several study reports, regulatory guidelines have been formulated in the UK, USA and Europe to reduce inappropriate prescriptions of antipsychotics for the treatment of behavioral and psychological symptoms of dementia. To date, few studies have provided evidence of the association between antipsychotic prescription in older adults with dementia and the risk of several diseases such as myocardial infarction, venous thromboembolism, ventricular arrhythmia, and acute kidney injury.

About the study

The current study examined the risk of adverse outcomes associated with antipsychotics in a large cohort of adults with dementia. Some adverse outcomes considered in this study were venous thromboembolism, stroke, heart failure, ventricular arrhythmia, bone fractures, myocardial infarction, pneumonia, and acute kidney injury.

Over 98% of the UK population is registered with the National Health Service (NHS) general practice system. All relevant data were collected from the Clinical Practice Research Datalink (CPRD) electronic health records, which is linked to over 2,000 general practices. CPRD includes the Aurum and GOLD databases, which can be considered broadly representative of the UK population.

People over 50 years of age who were diagnosed with dementia were recruited. Importantly, none of the study participants received antipsychotic intervention a year before their diagnosis.

The researchers used a matched cohort design in which each patient who took antipsychotic medications after their initial dementia diagnosis was matched using the incidence density sampling method. This method included up to 15 randomly selected patients who were diagnosed with dementia on the same day but were not prescribed antipsychotic medication.

Antipsychotics increase the risk of adverse effects in dementia patients

Across both cohorts, the average age of participants was 82.1 years. A total of 35,339 participants were prescribed an antipsychotic during the study period.

The average number of days between the first dementia diagnosis and the date of the first antipsychotic prescription was 693.8 and 576.6 days for Aurum and GOLD, respectively. The most commonly prescribed antipsychotics were risperidone, haloperidol, olanzapine, and quetiapine.

The current population-based study found that adults with dementia who are prescribed antipsychotics have a higher risk of venous thromboembolism, myocardial infarction, stroke, heart failure, pneumonia, fractures and acute kidney injury than non-users. This observation was based on analysis of 173,910 adults with dementia selected from both databases.

The increased risk of adverse outcomes was most commonly observed among current and recent antipsychotic users. After 90 days of taking antipsychotics, the risk of venous thromboembolism, pneumonia, acute kidney injury and stroke was higher than in non-users. However, antipsychotics had no effect on the risk of ventricular arrhythmia, appendicitis, and cholecystitis.

Compared to risperidone use, haloperidol was significantly associated with an increased risk of pneumonia, bone fractures, and acute kidney injury. Although the side effects of haloperidol were higher than those of quetiapine, no significant differences were observed between risperidone and quetiapine in the risk of fracture, heart failure and myocardial infarction. The risk of pneumonia, stroke, acute kidney injury and venous thromboembolism was lower with quetiapine than with risperidone.

Conclusions

The current study sheds light on how antipsychotics affect older people with dementia. The use of these drugs has been associated with many serious side effects, such as stroke, acute kidney injury, pneumonia, venous thromboembolism, heart failure and myocardial infarction.

In the future, these risks, along with cerebrovascular events and mortality, need to be considered when making regulatory decisions regarding the use of antipsychotics for the treatment of dementia in older adults.

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