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Again, Higher Mortality with Antipsychotics in Patients with Dementia

Both conventional and atypical antipsychotics were associated with higher mortality.

Although antipsychotic drugs are prescribed widely to control neuropsychiatric symptoms in patients with dementia, recent studies suggest questionable efficacy (Journal Watch Oct 11 2006) and an association with increased mortality (Journal Watch Psychiatry Nov 2 2005). This retrospective cohort study compared mortality rates in patients with dementia who received antipsychotic drugs and those who received psychiatric medications other than antipsychotics.

Using a U.S. Veterans Affairs database, researchers identified 10,615 patients who began outpatient treatment with psychiatric medication following a dementia diagnosis. One-year mortality was 25% in users of conventional antipsychotics, 23% in users of atypical antipsychotics, 15% in users of other psychiatric drugs (e.g., antidepressants and anxiolytics/hypnotics), and 18% in a cohort of dementia patients who did not take psychiatric medication. After adjustment for medical comorbidities, mortality was significantly higher in patients who took antipsychotics (conventional or atypical) than in patients who took psychiatric drugs other than antipsychotics. Mortality in the non-antipsychotic medication group was similar to that in the no-medication group.

Comment: Once again, use of antipsychotic drugs was associated with increased mortality in patients with dementia. Although confounding could account for these results, statistical adjustment for confounding variables was extensive, and patients who received antipsychotics actually had slightly less measured medical comorbidity than those who received other drugs. Thus, this study gives us yet another reason to avoid antipsychotic drugs in demented patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 11, 2007

Citation(s):

Kales HC et al. Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. Am J Psychiatry 2007 Oct; 164:1568.

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