CJ Arlotta 3/19/2015 7:45AM
Even though practitioners can prescribe several other medications for
dementia patients, many physicians still resort to antipsychotics —
despite the known increase of potentially damaging side effects. In
fact, antipsychotics may actually speed up the dying process in dementia
patients more than previously realized, a new study shows.
With the hopes of learning more about the harms associated with using antipsychotics in dementia patients, researchers from the University of Michigan Medical School and VA Center for Clinical Management Research pulled
data from the VA national electronic health record system to analyze
nearly 91,000 veterans over the age of 65 with dementia. They published
their findings in the latest issue of the Journal of the American Medical Association (JAMA).
Dr. Donovan Maust, lead author of the study and assistant professor
of Psychiatry at the University of Michigan, told Forbes that many
people don’t realize the behavioral and psychological symptoms of
dementia. These common symptoms include delusions, hallucinations,
agitation and aggression. “These symptoms are very distressing to
caregivers and are responsible for a significant amount of the cost
associated with caring for patients with dementia,” Maust said. “These
behaviors may be dangerous and place the patient at risk for harming
themselves, their family and other caregivers.”
“The fact that antipsychotic use persists in spite of the evidence of
harm speaks to both how problematic these behaviors are and that there
are few other interventions available,” he added.
Alternatives to using antipsychotics for dementia patients include
valproic acid, cholinesterase inhibitors and antidepressants. “Non-drug
behavioral interventions are important alternatives, but they are
generally time-intensive with limited mechanisms for reimbursement, so
are not widely available,” Maust said.
The study found that patients taking antipsychotics may face a
higher risk of mortality. Risk climbed along with dose in patients
using newer, more commonly used antipsychotics. The reasoning for this,
according to Maust, is unknown.
“One possibility is that a higher dose means patients are more
sedated, which might lead to more falls or more aspiration,” he said.
“In frail older patients, such events could ultimately hasten death.”
Patients in the study taking haloperidol had an increased mortality
risk of 3.8% compared to matched nonusers. Those participants receiving
quetiapine had an increased risk of death of 2.0%. Other tested
antipsychotic drugs had fallen somewhere in between.