Antipsychotic Drugs: OK for Dementia Patients?

Oct. 18, 2005 -- A new generation of antipsychotic drugs may slightly increase the risk of death when used to treat common behavioral and psychological problems in people with dementia.

The new drugs include Abilify, Zyprexa, Seroquel, and Risperdal.

A new review of clinical trials that treated people with dementia shows 3.5% of those prescribed the drugs died compared with 2.3% of those who took a placebo.

Researchers say most elderly people with dementia develop aggression, delusions, and other psychiatric symptoms; antipsychotic drugs are commonly used to treat those symptoms.

In the last decade a new generation of antipsychotic drugs has largely replaced the older conventional antipsychotics and has become the preferred treatment for behavioral problems associated with dementia. The older generation of drugs was associated with more pronounced side effects.

But researchers say concerns have arisen about possibly increased risk for death, stroke, and quickened mental decline.

Death Risk Tied to Common Dementia Treatment

In the study, which appears in The Journal of the American Medical Association, researchers analyzed information from 15 clinical trials of new antipsychotic drugs in treating people with dementia to see if there was any increased risk of death.

The results showed that death occurred more often among participants who were randomly assigned to receive one of the new antipsychotic drugs than those who received a placebo.

Researchers say most of the studies were 10 to 12 weeks long, and the fact that an increase in the risk of death as well as cerebrovascular events, such as stroke, was found in this short time period is concerning and suggests that these drugs should be used with care.

What to Do

In an editorial that accompanies the study, Peter V. Rabins, MD, MPH, and Constantine G. Lyketsos, MD, MHS, of Johns Hopkins Medical Institutions in Baltimore, say antipsychotic drugs are used to treat the psychological and behavioral symptoms that affect 60% to 90% of people with dementia.

In light of these results, they say other possible causes of behavioral and psychological problems, such as untreated or undertreated medical illnesses, overmedication, and lack of engaging activities, should be considered before treating these symptoms in people with dementia.

In addition, the risks and benefits of treatment with antipsychotic drugs should be weighed for each person. If antipsychotic drugs are prescribed, then careful monitoring is necessary.

SOURCES: Schneider, L. The Journal of the American Medical Association, Oct. 19, 2005; vol 294: pp 1934-1943.