The research, published in The BMJ (British Medical Journal), correlates antipsychotic drug use by people with dementia with elevated risks of heart attack, stroke, heart failure, blood clots, irregular heart rhythm, pneumonia,
fracture, and acute kidney injury when compared to people with dementia who are not using antipsychotics.
The study authors said the highest risk of side effects comes soon after people start the medications. They said this fact highlights the need for more caution during the early stages of treatment.
The researchers pointed out that antipsychotics are widely prescribed for psychological and
behavioral symptoms of dementia, including depression, anxiety, irritability, aggression, apathy,
delirium, and psychosis.
They said the typical regulatory warnings accompanying antipsychotics cover only increased risk for stroke and
death. They added that this research highlights the expanded risks of antipsychotics when used for dementia.
Details from the study of antipsychotic drugs as a dementia treatment
The researchers said they found the potential health issues by combing through primary care, hospital, and mortality data in England.
They identified 173,910 people, 63% of whom were women, who were diagnosed with dementia. The average age of individuals in the study was 82.
The subjects were diagnosed between January 1998 and May 2018 and weren’t prescribed an antipsychotic the year before their diagnosis.
The researchers matched up 35,339 people prescribed an antipsychotic on or after the day of their
dementia diagnosis with 15 randomly selected people with dementia who didn’t take antipsychotics.
Researchers excluded people from the analysis who had a history of each specific outcome under
investigation before their diagnosis. They said they also accounted for possible factors such as personal patient characteristics, pre-existing medical conditions, lifestyle, and prescribed drugs.
Dementia and the risk of taking antipsychotic drugs
The researchers reported that antipsychotic drug use was associated with increased risks for all outcomes, except ventricular arrhythmia, compared with people with dementia who weren’t taking the medications.
For example, during the first three months of treatment, researchers reported that the pneumonia rates among people taking antipsychotics were 4.48%, compared to 1.49% for non-users. After a year of antipsychotic use, that rate rose to 10.41% for users, compared to 5.63% for non-users.
The researchers said the risk of acute kidney injury was highest among people taking antipsychotic drugs (1.7-fold
increased risk). In addition, the risk of stroke and venous thromboembolism (1.6-fold increased risk) were higher when compared against non-users.
For almost all of the outcomes, they said the risks were highest during the first week of antipsychotic treatment, particularly for pneumonia.
Researchers said their study was observational and they couldn’t draw firm conclusions about cause and effect. They also said some misclassification of antipsychotic use may have occurred.
Although they said they adjusted for a range of factors, the researchers couldn’t rule out other unmeasured
variables affected their results.
They also said their study was a large analysis based on reliable health data investigating a wide range of
adverse events over several time periods.
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