January 9, 2009

Antipsychotics Nearly Double Death Risk in Alzheimer’s Patients

Antipsychotic drugs may result in an almost doubled risk of death in Alzheimer's patients, according to a study conducted by British researchers.

The study, published Friday in the medical journal Lancet Neurology, supported previous notions that prolonged use of antipsychotic drugs can carry serious health risks, including Parkinson-like symptoms, sedation, chest infections, decline in brain function, stroke and death.

"For the vast majority of Alzheimer's patients, taking these drugs is probably not a worthwhile risk," said Clive Ballard, the paper's lead author, of the Wolfson Centre for Age-Related Diseases at King's College London.

"Would I want to take a drug that slightly reduced my aggression but doubled my risk of dying? I'm not sure I would," Ballard said.

"Antipsychotics are not and never were indicated for use in people with dementia," said dementia expert Dr. P. Murali Doraiswamy, chief of the biological psychiatry division at Duke University. "But millions of elderly [people] were put on antipsychotics in nursing homes, often with little or no evidence to support such use."

Ballard's team studied a group of 165 Alzheimer's patients who received either antipsychotics - thioridazine, chlorpromazine, haloperidol, trifluorperazine or risperidone "“ or a placebo. Participants ranged in age from 67 to 100.

Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Pneumonia was the most common cause of death in both groups, researchers said.

After one year of follow-up, 70 percent of the patients taking antipsychotics were still living, compared with 77 percent of those on placebo.
After two years, 46 percent of those prescribed antipsychotics were still alive, compared to 71 percent of those taking placebo. And after three years, only 30 percent of those on antipsychotics were alive, compared with 59 percent of those taking a placebo, the researchers found.

"Our opinion is that there is still an important but limited place for atypical antipsychotics in the treatment of severe neuropsychiatric manifestations of Alzheimer's disease, particularly aggression," the researchers wrote. "However, the accumulating safety concerns, including the substantial increase in long-term mortality, emphasize the urgent need to put an end to unnecessary and prolonged prescribing."
Doraiswamy told the Washington Post that antipsychotics should be used only "as a measure of last resort."

"If there is no other way to stop an Alzheimer's patient from acting dangerously and all other measures have failed, then antipsychotics can be used," he said. "But only for the shortest possible time at the lowest possible dose."


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