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Hallucinations increase risk for relapse in Alzheimer’s disease

Individuals with Alzheimer’s disease who presented with hallucinations, particularly auditory, were more likely to relapse after discontinuing antipsychotic treatment.

“Data are lacking on which types of neuropsychiatric symptoms increase the risk of relapse after discontinuation of antipsychotic treatment. In order for clinicians to make informed judgments about which patients can safely discontinue their antipsychotic medication and which patients need to continue treatment, it is important to identify which symptoms are associated with an increased likelihood of relapse after antipsychotic discontinuation,” Anjali N. Patel, DO, of New York State Psychiatric Institute, Columbia University, and colleagues wrote.

To identify neuropsychiatric symptoms that predict relapse after discontinuation of antipsychotic treatment in Alzheimer’s disease, researchers conducted post-hoc analyses of the Antipsychotic Discontinuation in Alzheimer’s Disease trial, a randomized clinical trial of 180 individuals with Alzheimer’s disease and agitation or psychosis. Study participants received risperidone for 16 weeks and those who responded (n = 110) were randomly assigned to continue risperidone for 32 weeks, continue risperidone for 16 weeks followed by placebo for 16 weeks or to receive placebo for 32 weeks. Researchers assessed associations between the 12 symptom domains in the Neuropsychiatric Inventory and relapse in the first 16-week phase after randomization.

Previously reported findings indicated discontinuation of risperidone was associated with a 2- to 4-fold increased risk for relapse over 16 to 32 weeks.

Post-hoc analysis indicated that participants who presented with severe hallucinations at baseline were more likely to relapse (HR = 2.96; 95% CI, 1.52-5.76), compared with those with mild or no hallucinations.

This association was found among participants with auditory hallucinations but not those with visual hallucinations.

Approximately 76.5% of participants with baseline hallucinations who discontinued risperidone relapsed, compared with 38.5% who continued risperidone (P < .02).

This difference remained significant when comparing severe (77.8%) and mild hallucinations (36%).

Relapse was not associated with Neuropsychiatric Inventory domain scores after the initial open-treatment phase.

“Our findings in this study indicate that the subgroup of patients with hallucinations is at a high risk of relapse after discontinuation of antipsychotic treatment,” the researchers wrote. “In patients with dementia and severe psychotic symptoms, particularly auditory hallucinations, subsequent discontinuation after treatment response, if attempted, should be accompanied by close monitoring for symptom recurrence. Antipsychotic medication may need to be promptly reinstated if relapse occurs.” – by Amanda Oldt

Disclosure: Patel reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.