This article is more than 5 years old. Information may no longer be current.
Antipsychotic use in Alzheimer's disease increases mortality risk
Click Here to Manage Email Alerts
Antipsychotic use was associated with increased risk for mortality among individuals with Alzheimer’s disease and remained increased 2 years after initiation, according to recent findings.
“Despite safety concerns and modest efficacy, antipsychotic use has remained frequent among persons with dementia,” Marjaana Koponen, MSc, of the University of Eastern Finland, and colleagues wrote. “Although prevalence of antipsychotic use has declined in some countries, this trend has not been observed everywhere. Even antipsychotic polypharmacy (use of at least two antipsychotics concomitantly) has been observed among community-dwellers with [Alzheimer’s disease], although there is no evidence of efficacy and safety of antipsychotic polypharmacy in the treatment of behavioral and psychological symptoms of dementia.”
To determine mortality risk associated with antipsychotic use duration, polypharmacy and monotherapy in Alzheimer’s disease, researchers analyzed data from a nationwide register-based study for 70,718 community dwelling individuals diagnosed with Alzheimer’s disease in Finland from 2005 to 2011. Deaths due to cancer were excluded from analysis.
Antipsychotic use was associated with an increased risk for mortality (adjusted HR = 1.61; 95% CI, 1.53-1.7).
Absolute difference in mortality rate was 4.58 (95% CI, 4.53-4.63) deaths per 100 person-years.
Mortality risk was increased from the first days of use and gradually decreased but remained increased after 2 years of use (aHR = 1.3; 95% CI, 1.16-1.46).
Antipsychotic polypharmacy (aHR = 2.88; 95% CI, 2.38-3.49) was associated with a higher risk for mortality than monotherapy (aHR = 1.57; 95% CI, 1.49-1.66), compared with nonuse.
Compared with risperidone, haloperidol was associated with a higher mortality risk (aHR = 1.52; 95% CI, 1.14-2.02) and quetiapine was associated with lower risk (aHR = 0.84; 95% CI, 0.75-0.94).
“Our findings support current treatment guidelines on having a high threshold for antipsychotic initiation among persons with [Alzheimer’s disease]. If antipsychotic use is deemed necessary, the lowest effective dose should be used and duration should be limited with regular attempts of withdrawal, as the mortality risk remains elevated in long-term use,” the researchers wrote. “Antipsychotic polypharmacy should be avoided as the risk of mortality was higher than in monotherapy. The antipsychotic drug choice should be weighed against risk/benefit evidence.” – by Amanda Oldt
Disclosure: Please see the study for a full list of relevant financial disclosures.