A recent study conducted by a collaboration across the Universities of Manchester, Nottingham, Edinburgh, and Dundee has revealed that the use of antipsychotics in individuals with dementia is associated with a higher risk of various serious health outcomes compared to non-use.
Published in The BMJ and funded by the National Institute for Health and Care Research (NIHR), the study found increased rates of stroke, blood clots, heart attack, heart failure, fractures, pneumonia, and acute kidney injury among individuals prescribed antipsychotics.
These findings suggest a broader spectrum of harms linked to antipsychotic use in people with dementia than previously recognized, particularly in the initial stages of treatment. Co-investigator Professor Tony Avery, OBE, emphasized the importance of considering these risks when prescribing such medications and advocating for alternative approaches whenever possible.
Despite ongoing safety concerns, antipsychotics continue to be widely prescribed for behavioral and psychological symptoms associated with dementia, such as aggression, anxiety, and psychosis. Previous regulatory warnings were primarily focused on stroke and death risks, with limited evidence on other adverse outcomes.
To address this gap, researchers investigated several adverse outcomes potentially associated with antipsychotic use in people with dementia, including stroke, blood clots, heart attack, heart failure, fractures, pneumonia, and acute kidney injury.
Using linked primary care, hospital, and mortality data in England, the study analyzed a large cohort of individuals diagnosed with dementia. Each patient prescribed antipsychotics was matched with non-users, and potentially influential factors were taken into account.
The study found increased risks for all outcomes among antipsychotic users compared to non-users, particularly in the first weeks of treatment. For example, rates of pneumonia were significantly higher among antipsychotic users within the first three months of treatment.
While the study provides valuable insights, its observational nature limits the ability to establish causation. Nonetheless, the findings underscore the need for careful consideration of the benefits and risks of antipsychotic treatment in individuals with dementia, with regular review of treatment plans across healthcare settings.
Lead author Dr. Pearl Mok emphasized the importance of further research into safer drug and non-drug treatments for behavioral and psychological symptoms of dementia, particularly given the projected increase in dementia cases in the coming years.
