Study links dementia antipsychotics to higher risks of serious health outcomes

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The neurodegenerative condition currently affects more than 944,000 people living in the UK

Researchers from the Universities of Manchester, Nottingham, Edinburgh and Dundee have revealed in a study that antipsychotic use in dementia patients is associated with higher risks of a wide range of serious health outcomes.

The study was published in The BMJ and funded by the National Institute for Health and Care Research (NIHR).

Affecting more than 944,000 people in the UK, dementia is a neurodegenerative condition that impairs the ability to think or make decisions.

Using linked primary care, hospital and mortality data in England, the team identified 173,910 people diagnosed with dementia at an average age of 82 between 1998 and 2018 who had not been prescribed antipsychotics in the year prior to diagnosis.

Researchers identified 35,339 patients who were prescribed an antipsychotic either before or after their dementia diagnosis and matched them with up to 15 randomly selected patients who had not used antipsychotics.

Antipsychotic drugs are used to treat people experiencing severe agitation, aggression or distress from psychotic symptoms, such as hallucinations or delusions.

The most commonly prescribed antipsychotics identified in the study were risperidone, quetiapine, haloperidol and olanzapine, accounting for nearly 80% of all prescriptions.

Antipsychotics were associated with increased risks for all outcomes of interest – stroke, major bloody clots, heart attack, heart failure, ventricular arrhythmia, fractures, pneumonia and acute kidney injury – except ventricular arrhythmia.

After one year, rates of pneumonia among antipsychotic users rose to 10.41% from 4.48% after the first three months, compared to 1.49% after three months and 5.63% for non-users after one year.

Co-investigator professor Tony Avery, University of Nottingham and NIHR senior investigator commented: “Our study shows that the use of antipsychotics in this group of patients is also associated with other harms…, [meaning] that it is even more important to take account of [the] risk of harm when considering prescribing these medicines and to use alternative approaches wherever possible.”

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