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Antipsychotic Use in Dementia Patients Linked to High Risks, According to New Study

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A recent study published in the BMJ highlights the significant risks associated with antipsychotic use in dementia patients, revealing a wide range of serious adverse outcomes. The population-based matched cohort study, conducted using data from the Clinical Practice Research Datalink (CPRD) in England, evaluated the health impacts of antipsychotic medications on adults diagnosed with dementia over a period spanning from 1998–2018.

The study, led by Dr. Pearl L H Mok from the University of Manchester, aimed to investigate the risks of multiple adverse outcomes linked to antipsychotic use in dementia patients. The research utilised linked primary care, hospital, and mortality data to conduct a comprehensive analysis. The study population consisted of 173,910 adults aged 50 and above, with a diagnosis of dementia. Among these, 35,339 new users of antipsychotic medications were matched with up to 15 non-users for comparison.

The findings of the study indicate that antipsychotic use is associated with increased risks of several adverse outcomes, including stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury. Notably, the study found that the risks were highest within the first 90 days of antipsychotic use. For instance, the hazard ratio for pneumonia during this period was 2.19, indicating more than double the risk compared to non-users. Similarly, the hazard ratio for acute kidney injury was 1.72, and for stroke, it was 1.61.

The study’s results underscored that the absolute risks and risk differences were particularly significant for pneumonia. The cumulative incidence of pneumonia in the 90 days following antipsychotic initiation was 4.48% among users, compared to 1.49% in the non-user cohort, highlighting a substantial risk difference of 2.99% . Moreover, the study reported that the risk of myocardial infarction increased by 1.28 times, and the risk of heart failure by 1.27 times among antipsychotic users compared to non-users.

Importantly, the study noted that these risks were more pronounced with typical antipsychotics compared to atypical antipsychotics. For example, haloperidol, a typical antipsychotic, was associated with higher risks of fracture, pneumonia, and acute kidney injury compared to risperidone, an atypical antipsychotic.

These findings have significant implications for clinical practice and regulatory guidelines. The study’s authors emphasise that the range of adverse outcomes associated with antipsychotic use in dementia patients is broader than previously recognised. This calls for heightened vigilance in prescribing these medications and underscores the importance of regular treatment reviews to weigh the potential benefits against the risks.

The study also highlights the need for non-pharmaceutical interventions to manage behavioural and psychological symptoms of dementia, which are often the primary reasons for antipsychotic prescriptions. Current guidelines from the National Institute for Health and Care Excellence (NICE) recommend that antipsychotics should only be used when non-drug interventions have proven ineffective, and even then, they should be prescribed at the lowest effective dose for the shortest possible duration.

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