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Antipsychotics Up Death Risk in Alzheimer's Patients

Long-term study says the drugs should only be used short-term, as last resort

FRIDAY, Jan. 9 (HealthDay News) -- Alzheimer's patients who are prescribed antipsychotic drugs face a higher risk of death than similar patients not given these medications do, British researchers report.

While the short-term use of antipsychotics has been found to benefit Alzheimer's patients, studies have found that prolonged use can have serious side effects, including Parkinson-like symptoms, sedation, chest infections, decline in brain function, stroke and death.

"It's an eye-opening study since it was one of the few non-company sponsored studies to look at long-term risks," said dementia expert Dr. P. Murali Doraiswamy, chief of the biological psychiatry division at Duke University.

"Antipsychotics are not and never were indicated for use in people with dementia," he added. "But millions of elderly [people] were put on antipsychotics in nursing homes, often with little or no evidence to support such use."

For the study, lead researcher Dr. Clive Ballard, of the Wolfson Centre for Age-Related Diseases at King's College London, and his colleagues randomly assigned 128 Alzheimer's patients to one of several antipsychotics or a placebo. The antipsychotic drugs included thioridazine, chlorpromazine, haloperidol, trifluorperazine or risperidone.

The researchers found that, for the whole study period, the risk of death was 42 percent lower among people taking a placebo compared with those taking antipsychotics.

After one year of follow-up, 70 percent of the patients taking antipsychotics were still living, compared with 77 percent of those on placebo.

But after two years, 46 percent of those taking antipsychotics were alive, compared with 71 percent of those taking placebo. And after three years, only 30 percent of those on antipsychotics were alive, compared with 59 percent of those taking a placebo, the researchers found.

The findings were published online Jan. 8 in The Lancet Neurology.

Despite the findings, Doraiswamy said there's still a place for antipsychotics in some people with dementia. "If there is no other way to stop an Alzheimer's patient from acting dangerously and all other measures have failed, then antipsychotics can be used as a measure of last resort, but only for the shortest possible time at the lowest possible dose," he said.

The study authors agreed.

"Our opinion is that there is still an important but limited place for atypical antipsychotics in the treatment of severe neuropsychiatric manifestations of Alzheimer's disease, particularly aggression," the researchers wrote. "However, the accumulating safety concerns, including the substantial increase in long-term mortality, emphasize the urgent need to put an end to unnecessary and prolonged prescribing."

William Thies, chief medical officer at the Alzheimer's Association, said his group suggests that "non-pharmacological treatments" may be as effective as the antipsychotic drugs and should be considered first.

"Non-pharmacological treatments are things like changing the environment of the patient, changing the way the patient is addressed, and eliminating certain triggering events that may cause deteriorations in patient behavior," he said.

More information

For more on Alzheimer's disease, visit the Alzheimer's Association.

What You Need to Know About Antipsychotics

"Families need to be on the lookout and question their doctor closely if he or she recommends an antipsychotic for Alzheimer's," said Dr. P. Murali Doraiswamy, chief of the biological psychiatry division at Duke University.

He said families need to ask:

  • What is it for?
  • Why did you choose it? Is this the lowest dose that works?
  • Have you considered an alternative?
  • How long will my relative need to be on it?
  • How often will my relative be checked for side effects?

SOURCES: P. Murali Doraiswamy, M.D., chief, biological psychiatry division, Duke University, Durham, N.C., William Thies, Ph.D., chief medical officer, Alzheimer's Association; Jan. 8, 2009, The Lancet Neurology, online

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