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Recent research has unveiled a concerning association between antipsychotic use in older adults with dementia and a significantly heightened risk for various serious health complications, including stroke, myocardial infarction, heart failure, pneumonia, fracture, acute kidney injury, and more.
The findings, published in the BMJ on April 17, underscore the urgent need for heightened caution when prescribing antipsychotic medications to manage psychological symptoms of dementia. Lead investigator Pearl Mok, a research fellow at the Centre for Pharmacoepidemiology and Drug Safety at The University of Manchester, emphasized the broader scope and severity of adverse events linked to antipsychotic use compared to previous reports.
The study, a matched cohort analysis, drew upon patient registry data encompassing nearly 174,000 individuals diagnosed with dementia. Researchers compared outcomes between those prescribed antipsychotics after their dementia diagnosis and those who did not receive such prescriptions.
The results revealed a substantial elevation in the risk of adverse events among individuals using antipsychotics. Specifically, any antipsychotic use was associated with double the risk of pneumonia, a 1.7-fold increased risk of acute kidney injury, and 1.6-fold higher odds of venous thromboembolism compared to nonuse. Moreover, the study identified heightened risks for stroke, fracture, myocardial infarction, and heart failure among antipsychotic users.
Of particular concern is the timing of these adverse events, with the highest risk observed within the first week of treatment initiation. The cumulative incidence of pneumonia among antipsychotic users within one year was notably higher compared to nonusers, underscoring the critical need for vigilant monitoring during the early stages of treatment.
Lead investigator Mok stressed the importance of weighing potential benefits against the substantial risks associated with antipsychotic treatment, urging clinicians to consider patients’ pre-existing comorbidities and support systems before prescribing these medications.
The study’s findings have prompted calls for a reevaluation of antipsychotic use in dementia care, with an emphasis on personalized, nuanced decision-making guided by comprehensive risk-benefit assessments.
Commenting on the study, experts underscored the necessity for specialist supervision and informed discussions with patients and their families when initiating antipsychotic treatment in individuals with dementia. While the study sheds light on the risks associated with antipsychotic use, it does not establish causality, prompting further investigation into the underlying mechanisms driving these adverse outcomes.
The research, funded by the National Institute for Health and Care Research, underscores the critical imperative for healthcare providers to exercise caution and prudence when considering antipsychotic treatment for individuals with dementia, prioritizing patient safety and well-being above all else.
