Antipsychotics Linked to Mortality Risks in Alzheimer’s Patients

Researchers find certain antipsychotic drugs increase risk of mortality amongst persons with Alzheimer’s Disease

Marta Pagán-Ortiz
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In a new study published in the Journal of Alzheimer’s Disease, researchers analyzed and compared the risk of mortality between commonly prescribed antipsychotic drugs amongst community-dwelling individuals with Alzheimer’s Disease (AD). Community-dwellers is a term often used to refer to elderly individuals who do not live in nursing homes. The team led by Finland-based investigator Marjaana Koponen, found that using antipsychotics was linked to a higher risk of mortality for this, a rate that was maintained throughout long-term use. The risk was greater for individuals using multiple antipsychotic medications concomitantly.

Antipsychotics are frequently used amongst individuals with dementia, including AD, to treat behavioral and psychological symptoms such as aggression and agitation. However, research has found antipsychotics can increase the risk of having a stroke in this population, in addition to other severe side effects. Previous research has found similar findings of increased mortality rates. Despite prior studies indicating safety risks of antipsychotics, clinical recommendations to reduce prescriptions, and Alzheimer’s-focused organizations’ focus on antipsychotic use reduction, prescription rates continue to be problematic.

Photo credit: flickr/photos/ragesoss
Photo credit: flickr/photos/ragesoss

For this study the authors utilized data from a nationwide register-based study that included individuals in Finland, who were living outside of nursing homes and care facilities, and diagnosed with dementia between 2005-2011. The study excluded individuals not using antipsychotics; individuals with a history of psychiatric disorders; and those with active cancer. Their sample was made up of 70,718 individuals, although only a percentage of that data was used based on antipsychotic use criteria. Death and causes of death were retrieved from another database, and the researchers excluded all cases in which cancer was a factor. Their analysis focused on risk comparison between the drugs, risk and length of use, and risk based on number of antipsychotics taken.

Of the most commonly prescribed antipsychotic drugs haloperidol (e.g. Haldol) was associated with the highest risk of mortality, followed by risperidone (e.g. Risperdal), and quetiapine (e.g. Seroquel). Further, the researchers found that antipsychotic polypharmacy (i.e. the prescription and usage of more than one medication) carried a higher risk of mortality than monotherapy. Results of their analysis also showed that although the risk peaked at the beginning of drug use, it remained increased in the long term, “even after two years of use”. Although previous research had already highlighted the association between antipsychotic drug use and mortality risk, this study contributed to the understanding of long-term use of these medications, as well as the risks caused by concomitant usage.

“In conclusion, the findings support current treatment guidelines on having a high threshold for antipsychotic initiation among persons with AD. Antipsychotic polypharmacy and long-term use should be avoided and drug choice should be weighed against risk/benefit evidence.”

 

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Koponen, M., Taipale, H., Lavikainen, P., Tanskanen, A., Tiihonen, J., Tolppanen, A. M., … & Hartikainen, S. (2016). Risk of mortality associated with antipsychotic monotherapy and polypharmacy among community-dwelling persons with Alzheimer’s Disease. Journal of Alzheimer’s Disease, (Preprint). (Abstract)

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7 COMMENTS

  1. These drugs have a BLACK BOX warning for 60-70% increased rate of mortality when used off-label in older adults. They are so overused that the US HHS has a program to reduce their off-label use in older adults. This study is more confirmation of the increased mortality, and the need for regular people to get this information so they can make informed decisions when these drugs are suggested, as they will continue to be. In at least one hospital in NYS, all older adults are routinely given haldol “so they can sleep”, and it is very difficult to get this stopped since it is hospital policy.

    • No, you and I both know that these older adults in one NYS hospital are not given Haldol so that they can sleep.

      They are given it so that the staff don’t have to see to their needs, since older adults can be very demanding. I understand that the older I get. When you have to depend on others to do so many things for you, you want things done correctly. But, most staff don’t want to have to see to the needs of these people so they drug them. It happens all the time in nursing homes every night all over this country. It is happening even in the so-called “good” nursing homes. And heaven help you if you are an older adult who speaks her or his mind and who calls people into question when they don’t do their jobs. You will be drugged immediately and will find yourself drooling in the geri-chair that they imprison you in for the rest of your days.

      The drug companies sent their drug representatives into the nursing homes to push Haldol and other antipsychotics because they realized that they had a lucrative and captive audience for their damned drugs.