Antipsychotics Harmful for Dementia Patients

<"">Antipsychotics, even when taken for a very short time period, are likelier to land elderly people with dementia in the hospital.  In some cases, patients died.  Researchers stress the underlying problems, which require the need for these medications—behavioral problems such as aggression and agitation—pose real issues.  Alternatives are limited, the researchers added.  “A misreading of the findings would be we don’t need to do something for these nursing home residents,” said study author Dr. Gary J. Kennedy, head of geriatric psychiatry for Montefiore Medical Center in New York City.  The findings were published in the May 26 issue of the Archives of Internal Medicine.

Many experts feel behavioral interventions should be tried first and antipsychotics used as a last resort, “when the behavior or the psychiatric symptoms are really out of control and causing complete distress not only for the person suffering from Alzheimer’s, but for caregivers all around them,” said Maria Carrillo, director of medical and scientific affairs at the Alzheimer’s Association in Chicago. “It’s important to work these things out with the physician and, of course, do follow-up very closely together, so you can make sure these antipsychotics are having the effect you want and, if not, discontinue them immediately.”

Antipsychotics are generally prescribed to treat some behavioral complications of dementia, including delirium.  Some newer antipsychotic medications such as Zyprexa (olanzapine) and Risperdal (risperidone) have been on the market for about a decade and have nearly replaced their older counterparts.

Researchers from the Institute for Clinical Evaluative Sciences in Ontario, Canada, compared 20,682 older adults with dementia living in the community with 20,559 older adults with dementia living in a nursing home between April 1, 1997, and March 31, 2004.  Each group was divided into three subgroups:  Those not receiving any antipsychotics, those taking newer antipsychotics, and those taking older antipsychotics such as Haldol (haloperidol).

The research revealed community-dwelling adults who recently received a prescription for a newer antipsychotic medication were 3.2 times more likely than individuals who received no antipsychotic therapy to be hospitalized or to die during 30 days of follow-up.  Those who received older antipsychotic therapy were 3.8 times more likely to have such an event compared to those who received no antipsychotic therapy.  In nursing home groups, those taking older antipsychotics were 2.4 times more likely to be hospitalized or die, while those taking newer drugs were 1.9 times more likely to die or be hospitalized during the 30 day follow-up.

“It’s a carefully done study,” Kennedy said. “One flaw is that the [participants] weren’t randomly administered antipsychotics.  There was some reason they were given an antipsychotic, such as aggression or agitation.”  The authors confirmed about 17 percent of patients entering nursing homes begin an antipsychotic within 100 days.”

Meanwhile, a recent British study concluded that the continuing use of antipsychotic drugs provides neither cognitive nor neuropsychiatric benefits when taken by Alzheimer’s patients. Research was conducted by King’s College Hospital in London where 165 patients who were already being treated with antipsychotic drugs were studied.  The patients were divided into two groups:  One continued treatment with the drugs; the other group stopped treatment.

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