Jun 5 2007
A new Canadian study by a geriatric medicine specialist has found that the antipsychotic drugs used to treat some of the disruptive behaviours of older adults with dementia may shorten the patient's life.
Antipsychotic drugs are used to treat psychotic conditions such as schizophrenia and mania but are also commonly prescribed to manage the behavioural symptoms of dementia, such as agitation, verbal or physical aggression and delusions, hallucinations or paranoia.
Dr. Sudeep Gill says the study suggests that both newer "atypical" antipsychotics and older conventional antipsychotics are associated with increased mortality, with the latter presenting the highest risk.
Dr. Gill says such drugs are associated with an early and sustained increase in risk of death when used to treat older adults with dementia.
Both Health Canada and the FDA issued warnings in 2005 regarding the risk, but as Dr. Gill says there was a dearth of information regarding the long-term impact of antipsychotics and the risks associated with the older conventional or typical antipsychotics.
The new study linked four administrative health care databases to look at health and death records of more than 27,000 people age 66 and older diagnosed with dementia between April 1, 1997, and March 31, 2002.
The researchers found the estimated mortality rate among study participants was high, especially in the long-term care setting and conventional antipsychotics were associated with higher risk for death than atypical antipsychotics which were associated with higher risk for death than no antipsychotic use.
These risks developed within one month of use, and persisted for up to six months.
Dr. Gill says the message is that even short-term use of these drugs can be associated with an increased risk of death, and doctors need to carefully monitor their use and weigh up the potential risks and benefits of using the drugs to manage the symptoms of dementia.
Dr. Gill does not totally dismiss the use of antipsychotic drugs to treat dementia, but he says they are not appropriate for everyday use for everyone with dementia.
He believes antipsychotics should not be initiated if effective non-drug treatments are available for specific problems or for symptoms, such as wandering, which are unlikely to respond to antipsychotic treatment.
Dr. Gill is anxious not to create a panic as the risk for an individual patient is relatively small, but the results are nevertheless clinically important.
He hopes the study will encourage discussion between patients and their physicians, and between caregivers and physicians, about the appropriate time to use such drugs.
Dr. Gill and his colleagues have called for better funding for non-drug interventions.
The study, "Antipsychotic Drug Use and Mortality among Older Adults with Dementia," is published in the June 5, 2007, issue of Annals of Internal Medicine.
The research was funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-Term Care.
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