Journals Club - Antipsychotic prescribing for patients with dementia

Dr Louise Newson brings us up to date with the latest research and guidance on prescribing for dementia.

MRI of patient with dementia
MRI of patient with dementia

Curriculum statement 9: Care of older adults

Key trials

  • Adverse effects for atypical antipsychotics in dementia patients have emerged in recent years. There is a threefold increase in risk of stroke with atypical drugs and mortality risk is raised for both typical and atypical antipsychotics (Lancet Neurol 2009; 8: 125).
  • One study found that among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable with, and possibly greater than, the risk of death associated with atypical antipsychotic medications (CMAJ 2007; 176: 627-32).
  • The DART-AD trial was the first long-term follow-up study to show that patients with Alzheimer's disease on antipsychotic drugs are at increased risk of mortality. Patients who received antipsychotic treatment for 12 months were more likely to have died by the 24-month and 36-month follow-up than patients who received placebo (Lancet Neurol 2009; 8: 151-7).

Evidence base

  • In view of the cerebrovascular adverse events and death associated with antipsychotic use in dementia patients, one article has highlighted the studies examining the risks and benefits of antipsychotic drugs. The authors conclude that weighing small but significant risks compared with benefits is a complex decision (J Psychosoc Nurs Ment Health Serv 2008; 46 : 19-23).

Guidelines

  • NICE guidance advises that clinicians should avoid using any antipsychotics for non-cognitive symptoms or challenging behaviour of dementia unless the patient is distressed or there is an immediate risk of harm to them or others. Any use of antipsychotics should include a full discussion with the patient and/or carers (NICE. Dementia. CG42. London, NICE 2006).

Contributed by Dr Louise Newson, a GP in the West Midlands.

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