Antipsychotic drugs increase health risks in patients with dementia

In a recent study published in the British Medical Journal, researchers assessed the side effects associated with the use of antipsychotic drugs in people with dementia.

Individuals diagnosed with dementia experience functional impairment and progressive cognitive decline. Some common psychological and behavioral symptoms of dementia include anxiety, depression, apathy, aggression, delirium, irritability and psychosis.

To manage the psychological and behavioral symptoms of dementia, patients are often treated with antipsychotic medications. The UK's National Institute for Health and Clinical Excellence currently recommends the use of antipsychotics only when non-pharmacological interventions are ineffective in relieving behavioral and psychological symptoms of dementia. However, there has been an increase in the use of antipsychotics during the recent coronavirus (COVID-19) pandemic, which has been attributed to lockdown measures and unavailability of non-drug treatments.

In the UK, risperidone and haloperidol are the only antipsychotics approved for the treatment of behavioral or psychological symptoms of dementia. In 2003, the US Food and Drug Administration (FDA) highlighted risks such as stroke, transient ischemic attack and mortality associated with the use of risperidone in older adults with dementia.

Based on numerous research reports, regulatory recommendations have been formulated in the UK, US and Europe to reduce inappropriate prescribing of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia. To date, few studies have provided data on the association between antipsychotic medication use in older adults with dementia and the risks of multiple diseases, such as myocardial infarction, venous thromboembolism, ventricular arrhythmia, and acute renal failure.

The current study examined the risk of adverse outcomes associated with antipsychotics in a large cohort of adults with dementia. Some of the adverse outcomes considered in this study included venous thromboembolism, stroke, heart failure, ventricular arrhythmia, fracture, myocardial infarction, pneumonia, and acute renal failure.

Over 98% of the UK population is registered with National Health Service (NHS) primary care. All relevant data were collected from electronic medical records stored in the Clinical Practice Research Database (CPRD), which is linked to over 2000 general practices. The CPRD includes the Aurum and GOLD databases, which can be considered broadly representative of the UK population.