Atypical antipsychotics pose safety risks for patients with dementia

Among community-dwelling patients diagnosed with dementia, less than a third have benefitted from antipsychotic treatment, while more than half endure a higher risk of adverse events, according to a recent study.

Eighty-one unique patients underwent a total of 87 distinct antipsychotic treatment periods. Of the patients, 33 percent continued antipsychotic treatment for more than a year, and only 17 percent discontinued treatment over the entire period.

Behavioural and psychological outcomes improved for 24 (28 percent) treatments, remained stable for 17 (20 percent) and worsened for 46 (53 percent).

More than half of the patients (53 percent) reported adverse events, with the most common being metabolic, fall-related, extrapyramidal symptoms type and vascular. Severe adverse events were few. A 20-percent risk of adverse events were found for every 90-day increase in duration of treatment (p=0.02).

This retrospective observational study of an academic outpatient memory disorders clinic included any community-dwelling patient with a diagnosis of dementia, not trauma-induced. Participants had documented behavioural and psychological symptoms of dementia (BPSD) treated with an atypical antipsychotic for at least 2 weeks.

The investigators reviewed medical records from 1 January 1990 to 23 March 2010. They documented safety outcomes from the time of antipsychotic treatment initiation, as well as behavioural and psychological efficacy outcomes beginning from 2 weeks following treatment initiation until the last documentation available.

“Options for the treatment of the BPSD are limited,” the investigators said. “Atypical antipsychotics are often used but have questionable efficacy and are generally considered high risk.”