A new study published in The BMJ (British Medical Journal) has expanded the list of potential health dangers associated with giving antipsychotic medications to people with dementia, by correlating their use with elevated risks of various health conditions such as heart attack, stroke, heart failure, blood clots, irregular heart rhythm, pneumonia, fracture, and acute kidney injury. The researchers found that the highest risk of side effects occurs soon after people start taking the medications, highlighting the need for caution, particularly during the early stages of treatment. Antipsychotics are commonly prescribed for psychological and behavioral symptoms of dementia, and the study emphasized the importance of considering the potential risks before starting individuals on these drugs, beyond the traditional regulatory warnings of stroke and death.
The researchers analyzed primary care, hospital, and mortality data in England to identify 173,910 individuals diagnosed with dementia who were not prescribed antipsychotics the year before their diagnosis. Of these, 35,339 were prescribed antipsychotics on or after the day of their dementia diagnosis. The study found that antipsychotic drug use was associated with increased risks of various health outcomes, with most risks being highest during the first week of treatment. While the study was observational and unable to establish causation, the findings suggested a significant association between antipsychotic use in people with dementia and adverse health outcomes.
Health experts emphasize the need for individualized treatment approaches for people with dementia considering antipsychotic medications. Dr. J. Wes Ulm, affiliated with the National Institutes of Health (NIH), highlighted the impact of antipsychotic drugs on multiple organ systems, indicating that individuals with underlying conditions may be particularly vulnerable to the drugs. He stressed the importance of weighing the potential risks against the benefits of treatment, particularly for individuals displaying severe psychotic signs and symptoms. Dr. David Merrill, a geriatric psychiatrist, recommended using non-pharmacological behavioral treatments before resorting to antipsychotic medications, particularly for behaviors due to dementia. He highlighted the importance of identifying and treating underlying medical issues that may drive behavioral agitation in individuals with dementia to optimize care.
Dr. Jason Krellman, a neuropsychologist, underlined the challenge of managing severe behavioral and psychological symptoms that can occur in later stages of dementia, such as agitation, aggression, hallucinations, and delusions. He acknowledged the difficult decision that providers and caregivers face in weighing the potential side effects of antipsychotic drugs against the benefits in managing severe symptoms. Despite the potential health risks associated with antipsychotic use in dementia patients, caregivers may struggle to provide adequate care, particularly for individuals with persistent and severe symptoms. The risk-benefit debate surrounding the use of antipsychotic medications in dementia underscores the need for personalized treatment approaches, considering factors such as age, severity of symptoms, and safety risks associated with untreated symptoms. Providers and caregivers must carefully evaluate the individual needs and circumstances of each dementia patient to make informed treatment decisions.
