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Antipsychotic Use In Elderly People With Alzheimer's Leads To Large Increase In Mortality

January 12, 2009

Adapted from Lancet

There is a large increased long-term risk of mortality in patients with Alzheimer's disease who are prescribed antipsychotic medication. These results, from long-term follow-up of the DART-Alzheimer's disease study*, further highlight the need to seek less harmful treatments for neuropsychiatric symptoms in these patients. These are the conclusions of an article published in the February edition of The Lancet Neurology, written by Dr Clive Ballard, Wolfson Centre for Age-Related Diseases, King's College London, UK, and colleagues.

While there is evidence of modest short term (6-12 weeks) benefits of antipsychotic treatment for the neuropsychiatric symptoms of Alzheimer's disease, there is also clear evidence of an increase in adverse effects, including parkinsonism, sedation, edema, chest infections, accelerated decline in brain function, stroke and mortality. However, all the data regarding mortality so far relate to short term follow-up of 12 weeks or less. The authors of this study have provided the first long-term follow-up data for Alzheimer's disease patients given antipsychotic drugs.

The authors conclude: "Our data add further serious safety concerns about the long-term use of antipsychotics in this population, and clinicians should certainly try to replace antipsychotics with safer management approaches. Several studies have shown that psychological management can replace antipsychotic therapy without any appreciable worsening of neuropsychiatric symptoms; and although cholinesterase inhibitors do not seem to be an effective short-term pharmacological treatment for agitation, there is evidence that memantine or antidepressants such as citalopram might be safer and effective alternatives for some neuropsychiatric symptoms.

"Our opinion is that there is still an important but limited place for atypical antipsychotics in the treatment of severe neuropsychiatric manifestations, particularly aggression, of Alzheimer's disease. 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."

The Leading Edge editorial in February's Lancet Neurology, also published Online first, concludes: "The risks and benefits of prescribing antipsychotics to patients with dementia need to be carefully balanced and these drugs should be used only if alternative strategies do not work. To protect the health and dignity of people with dementia and reduce the use of antipsychotic drugs, approaches that make the needs of patients central to decisions about care should be promoted."

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Some of the content in this section is adapted from other sources, which are clearly identified within each individual item of information.

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