British researchers have determined that antipsychotic drugs used to treat behavioral disorders of dementia, such as aggression, are associated with a significant risk of adverse outcomes such as heart attack, stroke, pneumonia and heart failure.
THE antipsychotic drugs used to counteract the behavioral disorders of the Alzheimer’s disease and other forms of dementia are associated with serious side effects (or more correctly, adverse outcomes), among which they appear stroke, myocardial infarction, pneumonia And heart failure. This is what emerged from a new study which compared the medical records of patients with dementia treated or not with this class of medicines. It has been observed that the incidence of severe pathologies increases significantly especially atstart of treatment, making the prescription of drugs even more delicate and controversial. Although possible and justified in certain circumstances, in fact, the use of antipsychotics to counteract aggression, agitation, delusions and other behavioral disorders linked to dementia has always been kept under close surveillance by the regulatory authorities, in light of the risks that have emerged in scientific literature (such as the increase in mortality).
These drugs, moreover, they do not cure neurodegenerationbut they only serve to “keep at bay” i symptoms above mentioned. Often, as explained to Agence France Press (AFP) by neurologist Charles Marshall, antipsychotics are prescribed to patients with dementia “only because there are not enough trained staff available who can safely manage their behavior”. This catalyzes the risk of very serious, potentially fatal consequences, as highlighted by the new investigation, therefore experts justify their use only in specific and rare circumstances.
A British research team led by scientists from the University of Manchester’s Division of Pharmacy and Optometry has determined that antipsychotic drugs used to treat the behavioral disorders of Alzheimer’s (and other forms of dementia) increase the risk of serious adverse outcomes. , who collaborated closely with colleagues from multiple institutes. Among those involved are the College of Medicine and Veterinary Medicine at the University of Edinburgh; the Nuffield Department of the University of Oxford; and the Faculty of Medicine at the University of Nottingham.
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The researchers, coordinated by Professor Pearl LH Mok, professor at the Center for Pharmacoepidemiology and Drug Safety of the English university, reached their conclusions after conducting a cohort study based on the population in which they were involved over 170,000 patients (63 percent women) with dementia, diagnosed between January 1, 1998 and May 31, 2018. Participants’ age was ≥50 years. Data were retrieved from the Clinical Practice Research Datalink (CPRD) database.
Scientists have identified in the group approx 35,000 patients undergoing treatment with antipsychotics, comparing their medical records with those of people with dementia not treated with these drugs. The objective was to verify the incidence of certain, serious, adverse outcomes. As indicated, in those prescribed medications for behavioral disorders the researchers observed a significant increase of such adverse outcomes, especially at the beginning of antipsychotic therapy. At 90 days after prescription, an association emerged with a 2.19 times higher risk of pneumonia; 1.72 times of acute kidney injury; 1.62 times of venous thromboembolism; 1.61 times of stroke; 1.43 times of fractures; 1.28 times of myocardial infarction; and 1.27 of heart failure. No associations with cardiac arrhythmia were found.
Among the antipsychotic drugs involved in the investigation are risperidoneL’haloperidolL’olanzapine and the quetiapine. As specified in a document published by the Veneto Region, risperidone is “the only second generation antipsychotic that is authorized in Italy for the short-term treatment of persistent aggression in patients with moderate to mild unresponsive AD to non-pharmacological approaches and when there is a risk of harming oneself or others’”. Other antipsychotics may be prescribed”off label” with various limitations and in any case carefully evaluated for the individual case, precisely in light of the potential risks they entail.
“Antipsychotic use compared to no use in adults with dementia was associated with an increased risk of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was broader than previously highlighted in regulatory advisories, with the highest risks immediately following initiation of treatment,” the authors noted in the abstract of the new study. It is important to underline that the British study was an observational study, therefore it will be necessary to conduct more in-depth investigations to reveal this cause-effect relationships with adverse outcomes. The details of the research “Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study” were published in the authoritative scientific journal British Medical Journal.
Tags: Alzheimers side effects antipsychotic drugs treat dementia
