Antipsychotics are used in people with dementia to manage behavioral and psychological symptoms that can be especially problematic for both patients and their caregivers. These symptoms include: physical or verbal aggression, delusions (false beliefs that can cause confusion), hallucinations (hearing voices or seeing things that are not real), anxiety or depression.
Although antipsychotics can help manage these symptoms in some cases, their use should be carefully considered by doctors because they are associated with the risk of serious side effects. In fact, new research by experts from the University of Manchester, the University of Nottingham, and the Universities of Edinburgh and Dundee has revealed that dementia patients who take antipsychotics are more likely to suffer strokes, blood clots, heart attacks , heart failure, fractures, pneumonia and acute kidney injuries.
The results of the study have been published in The BMJ and indicate that the harms associated with the use of antipsychotics are more extensive than previously recognized, especially in the early stages after starting treatment. This underlines the importance of proceeding very carefully when starting the use of these medications. This study was supported by the National Institute for Health and Care Research (NIHR).
“For many years there have been concerns about the safety of using antipsychotics to manage the behavioral and psychological symptoms of dementia, and an increased risk of stroke and death has been reported. Our study shows that the use of antipsychotics in this group of patients is also associated with other harms, such as pneumonia, venous thromboembolism, myocardial infarction, heart failure, fractures and acute kidney injury. “This means it is even more important to take into account the risk of harm when considering prescribing these medicines and use alternative approaches wherever possible,” explained Professor Tony Avery, from the University of Nottingham School of Medicine and Researcher. NIHR Senior.
Increased risk of pneumonia, stroke and kidney damage when taking antipsychotics
Despite these concerns, antipsychotics continue to be widely prescribed to treat symptoms such as apathy, depression, aggression, anxiety, irritability, and delusions and psychoses in people with dementia. Previously, regulatory warnings about prescribing antipsychotics for these symptoms were based on evidence of increased risks of stroke and death, but evidence of other adverse outcomes was less conclusive among people with dementia.
To clarify this uncertainty, the researchers analyzed the risks of several health problems potentially associated with the use of antipsychotics in people with dementia. The study used linked primary care, hospital and mortality data in England, identifying 173,910 people (63% women) diagnosed with dementia at an average age of 82 years, between January 1998 and May 2018, and who had not received antipsychotic prescriptions in the year prior to diagnosis.
They were compared with up to 15 randomly selected patients not using antipsychotics for each of the 35,339 patients who were prescribed an antipsychotic after their dementia diagnosis. The researchers also took into account factors that could influence the results, including the patient’s personal characteristics, her lifestyle, pre-existing medical conditions and prescribed medications.
The most commonly prescribed antipsychotics were risperidone, quetiapine, haloperidol and olanzapine, which together accounted for almost 80% of all prescriptions. Compared with nonuse, antipsychotics were associated with increased risks for all outcomes except ventricular arrhythmia. For example, in the first three months of treatment, pneumonia rates among antipsychotic users were 4.48% versus 1.49% among non-users. At one year, this proportion increased to 10.41% for antipsychotic users compared to 5.63% for non-users.
The use of antipsychotics in this group of patients is also associated with other harms, such as pneumonia, venous thromboembolism, myocardial infarction, heart failure, fractures, and acute kidney injury.
Although this is an observational study, no firm conclusions can be drawn about cause and effect, the research suggests that it is crucial that any potential benefits of antipsychotic treatment are carefully weighed against the risk of serious harm, and that treatment plans are reviewed. regularly in all health and care settings, said Professor Darren M Ashcroft from the University of Manchester.
“Given that the number of people living with dementia is expected to increase significantly in the coming years, more research is needed on safer pharmacological treatments and more effective non-pharmacological treatments for the behavioral and psychological symptoms of dementia,” concludes the doctor. Pearl Mok, research fellow at the University of Manchester.
Tom Russ, Professor of Geriatric Psychiatry and Honorary Consultant in Psychiatry at the University of Edinburgh, who was not involved in the study, told SMC Spain: “As someone who works with people with dementia in an acute admission ward in a hospital psychiatric, this study does not suggest to me that these medications should never be used, but they should be used sparingly in situations where other options have been explored (pain care, general health, psychosocial interventions including the Newcastle model and art therapies, as well as other medications).
For his part, Robert Howard, Professor of Geriatric Psychiatry in the division of Psychiatry at University College London (United Kingdom), has highlighted in statements to the same medium: “The study could not exclude reverse causality, where the presence of a physical illness such as Pneumonia could lead to delirium, which could then be treated with an antipsychotic medication, but all of us who prescribe in this situation should be aware of the risks of treatment. Initiation of these medications in people with dementia should only be under specialist supervision, with participation of patients and family members in informed discussions and reviews.”
