Antipsychotics May Do Great Harm to People With Dementia: Report

Antipsychotics can substantially increase dementia patients’ risk of many serious health problems, a new study warns.

Dementia patients prescribed antipsychotics have increased risk of stroke, blood clots, heart attack, heart failure, bone fractures, pneumonia and kidney damage, researchers reported April 17 in the BMJ.

“A move away from the overprescription of antipsychotics is overdue,” concluded the research team led by Pearl Mok, a research fellow with the University of Manchester in England.

The study adds impetus to an ongoing investigation by the U.S. Centers for Medicare and Medicaid Services into the overuse of antipsychotic drugs in nursing homes.

The investigation, announced last year, was launched in response to reports that some nursing homes might be falsely labeling patients as schizophrenic so they can be given antipsychotic drugs.

For the new study, researchers analyzed data on nearly 174,000 people in England diagnosed with dementia between January 1988 and May 2018, at an average age of 82.

More than 35,500 of those dementia patients had been prescribed an antipsychotic, and their health profiles were compared against up to 15 randomly selected patients who hadn’t used an antipsychotic.

Antipsychotic use more than doubled the risk of pneumonia among dementia patients, researchers found.

About 4.5% of dementia patients on antipsychotic drugs wound up developing pneumonia within three months of starting the meds, versus 1.5% of non-users.

The drugs were also associated with a 72% increased risk of kidney injury, a 62% increased risk of blood clots, a 61% increased risk of stroke, a 43% increased risk of bone fractures, a 28% increased risk of heart attack and a 27% increased risk of heart failure.

For all these outcomes, risks were highest during the first week on antipsychotics, particularly for pneumonia, researchers said.

The most commonly prescribed antipsychotics were risperidone, quetiapine, haloperidol, and olanzapine, researchers said. Together, these accounted for almost 80% of all prescriptions.

International guidelines advise restricting antipsychotic use to dementia patients with severe behavioral and psychological symptoms, the researchers noted.

However, the rate of antipsychotic prescriptions has risen in recent years, partly due to a scarcity of effective non-drug alternatives, as well as the substantial resources required to implement the alternatives that do exist, researchers said.

Antipsychotics can cause side effects like drowsiness, confusion, shaking and unsteadiness, the Alzheimer’s Society says. People taking them also have a higher risk of swollen lower limbs, infections and blood clots.

More information

The Alzheimer’s Society has more on antipsychotics and dementia.

SOURCE: BMJ, news release, April 17, 2024