Antipsychotic medications have long been a controversial subject when it comes to treating dementia patients. A recent population-based matched cohort study from the U.K. shed light on the significant risks associated with the use of antipsychotics in dementia patients. The study revealed that individuals prescribed antipsychotics were at a substantially higher risk of suffering from adverse outcomes compared to non-users. While previous regulatory alerts primarily focused on the risks of stroke and death, this study highlighted a much wider range of adverse effects associated with antipsychotic use in dementia patients.
The lead researcher of the study, Pearl Mok, PhD, emphasized that healthcare providers need to consider the extensive list of potential adverse outcomes before prescribing antipsychotics to individuals with dementia. The findings indicated that within 90 days of initiating antipsychotic treatment, patients were more than twice as likely to be diagnosed with pneumonia compared to non-users. Additionally, the increased risks extended to other serious conditions such as acute kidney injury, venous thromboembolism, stroke, fracture, myocardial infarction, and heart failure. The highest relative hazards were observed in the first week of antipsychotic use, with the risk of pneumonia nearly ten times higher during that initial period.
Despite the well-documented concerns about the safety of antipsychotics in dementia patients, these medications are still commonly prescribed to manage behavioral and psychological symptoms. Mok highlighted the limited efficacy of antipsychotics in treating these symptoms and stressed the importance of exploring alternative non-drug approaches whenever possible. In the United States, certain antipsychotics like risperidone come with black box warnings due to an increased risk of death when used in dementia-related psychosis.
The study’s results underscored the critical need for healthcare professionals to carefully weigh the risks and benefits of antipsychotic use in dementia care. The accompanying editorial by Raya Elfadel Kheirbek, MD, and Cristina LaFon, BS, emphasized that the expanded scope of known risks should inform personalized treatment decisions for individuals with dementia. The study called for a comprehensive assessment of the benefits versus the serious harms associated with prescribing antipsychotics in dementia patients.
To conduct the study, researchers collected data from electronic health records of over 170,000 adults diagnosed with dementia. The study period spanned two decades, allowing for a comprehensive analysis of the risks associated with antipsychotic use. Notable findings included the highest risk of adverse outcomes in the first week after initiating antipsychotic treatment, particularly for conditions such as stroke, acute kidney injury, and heart failure.
Among the antipsychotics prescribed, risperidone and quetiapine were the most common, followed by haloperidol and olanzapine. The study revealed that the risks of adverse outcomes differed among various antipsychotics, with haloperidol associated with higher risks for conditions like pneumonia and venous thromboembolism compared to quetiapine. Despite adjusting for a wide range of patient characteristics, the study’s observational approach posed limitations, and the potential for residual confounders could not be completely eliminated.
The study provided valuable insights into the extensive risks associated with antipsychotic use in dementia patients. Healthcare professionals must carefully consider these risks and explore alternative treatment options to ensure the safety and well-being of individuals with dementia. Ultimately, the study highlighted the urgent need for a more cautious and justified approach to prescribing antipsychotics in dementia care.
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