Summary

Dementia is often associated with challenging behavior, such as aggression and agitation. Antipsychotic drugs may be used to control this, but at some cost the person with dementia. A new study shows that older people with dementia living in the community on antipsychotics have double the risk of dying, and three times the risk of stroke compared to those not taking this medication.

Introduction

Antipsychotic drugs were originally developed to help people with schizophrenia. However, they have also been used to treat people with dementia, to address the behavioral and psychological symptoms that so often accompany the disease. This practice is not without risk - for previous studies have shown how these drugs can increase the risk of hip fracture, falls, stroke and death. However, the drugs are being used widely both in nursing homes and in the community. Medical researchers in Canada now report upon the impact of antipsychotic drugs among a group of people with dementia living in the community and in nursing homes.

What was done

The researchers looked at all Ontario residents aged 66 or older who had received a diagnosis of dementia and a prescription for antipsychotic drugs between 1997 and 2004. They sorted the participants into two groups - those living in a nursing home and those in the community. Then they divided these into two sub-groups, depending on whether they had been taking an older antipsychotic drug, like haloperidol, or one of the newer drugs, also known as atypicals, such as olanzapine. A control group of people with dementia who did not have a prescription for an antipsychotic was added to these participants.

The researchers then recorded any adverse event occurring within 30 days of starting the antipsychotic therapy and resulting in either hospitalization or death. There were 20,682 people with dementia dwelling in the community in the study and 20,559 in nursing homes.

What was found

The most frequently prescribed atypical antipsychotic drug in this study was risperidone, and the most frequently prescribed conventional antipsychotic was haloperidol. In the community, those with dementia who received an atypical antipsychotic were three times more likely, and those receiving a conventional antipsychotic four times more likely, to experience a serious adverse event within 30 days of starting their medication. The findings support other research which suggests that the conventional antipsychotic drugs are more risky for those with dementia. A similar pattern was observed for the group of nursing home residents.

What this study means

All patients with dementia are likely to be prescribed antipsychotics to manage their behavioral problems. But the practice is far more common in nursing homes. The researchers believe their study may even underestimate the problem associated with antipsychotics because mild symptoms were not included and nursing home residents may be managed within the home rather than being admitted to hospital. Moreover, follow up time was short - more people may develop problems in the long term. The take-home message for people with dementia, their carers, and doctors is that antipsychotic drugs ought to be used only as a last resort - for there are other, safer, ways in which agitation and aggression can be managed.