TY - JOUR
T1 - Implications of Adverse Outcomes Associated with Antipsychotics in Older Patients with Dementia
T2 - A 2011–2022 Update
AU - Rogowska, Marianna
AU - Thornton, Mary
AU - Creese, Byron
AU - Velayudhan, Latha
AU - Aarsland, Dag
AU - Ballard, Clive
AU - Tsamakis, Konstantinos
AU - Stewart, Robert
AU - Mueller, Christoph
N1 - Funding Information:
RS has received research support from Janssen, GSK and Takeda. DA has received research support and/or honoraria from Astra-Zeneca, H. Lundbeck, Novartis Pharmaceuticals and GE Health, and serves as a paid consultant for H. Lundbeck and Axovant. CB has received honoraria and grant funding from Acadia Pharmaceuticals, Lundbeck, Takeda and Axovant pharmaceutical companies. CB leads the Alzheimer’s disease psychosis (ADP) investigators group and has received honoraria from Lundbeck, Lilly, Otusaka and Orion pharmaceutical companies. MR, MT, BC, LV, KT and CM declare no conflicts of interest.
Funding Information:
CM, DA and RS receive salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and RS is a NIHR Senior Investigator. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2022, Crown.
PY - 2023/1
Y1 - 2023/1
N2 - Neuropsychiatric symptoms affect most patients with dementia over the course of the disease. They include a wide variety of symptoms from apathy and depression to psychosis, irritability, impulsivity and agitation. These symptoms are associated with significant distress to the patient and caregivers, as well as more rapid progression of dementia, institutionalisation and higher mortality. The first-line management of the neuropsychiatric symptoms of dementia should be non-pharmacological. If medications are required, antipsychotics are commonly chosen. Second-generation antipsychotics such as risperidone, olanzapine, quetiapine and aripiprazole are prescribed more often than first-generation antipsychotics, such as haloperidol. The aim of this review is to provide an update on findings on adverse outcomes and clinical implications of antipsychotic use in dementia. These medications may increase mortality and can be associated with adverse events including pneumonia, cerebrovascular events, parkinsonian symptoms or higher rates of venous thromboembolism. Risks related to antipsychotic use in dementia are moderated by a number of modifiable and non-modifiable factors such as co-prescribing of other medications, medical and psychiatric co-morbidities, and demographics such as age and sex, making individualised treatment decisions challenging. Antipsychotics have further been associated with an increased risk of reliance on long-term care and institutionalisation, and they might not be cost-effective for healthcare systems. Many of these risks can potentially be mitigated by close physical health monitoring of antipsychotic treatment, as well as early withdrawal of pharmacotherapy when clinically possible.
AB - Neuropsychiatric symptoms affect most patients with dementia over the course of the disease. They include a wide variety of symptoms from apathy and depression to psychosis, irritability, impulsivity and agitation. These symptoms are associated with significant distress to the patient and caregivers, as well as more rapid progression of dementia, institutionalisation and higher mortality. The first-line management of the neuropsychiatric symptoms of dementia should be non-pharmacological. If medications are required, antipsychotics are commonly chosen. Second-generation antipsychotics such as risperidone, olanzapine, quetiapine and aripiprazole are prescribed more often than first-generation antipsychotics, such as haloperidol. The aim of this review is to provide an update on findings on adverse outcomes and clinical implications of antipsychotic use in dementia. These medications may increase mortality and can be associated with adverse events including pneumonia, cerebrovascular events, parkinsonian symptoms or higher rates of venous thromboembolism. Risks related to antipsychotic use in dementia are moderated by a number of modifiable and non-modifiable factors such as co-prescribing of other medications, medical and psychiatric co-morbidities, and demographics such as age and sex, making individualised treatment decisions challenging. Antipsychotics have further been associated with an increased risk of reliance on long-term care and institutionalisation, and they might not be cost-effective for healthcare systems. Many of these risks can potentially be mitigated by close physical health monitoring of antipsychotic treatment, as well as early withdrawal of pharmacotherapy when clinically possible.
UR - http://www.scopus.com/inward/record.url?scp=85143892152&partnerID=8YFLogxK
U2 - 10.1007/s40266-022-00992-5
DO - 10.1007/s40266-022-00992-5
M3 - Review article
C2 - 36513918
AN - SCOPUS:85143892152
SN - 1170-229X
VL - 40
SP - 21
EP - 32
JO - Drugs and Aging
JF - Drugs and Aging
IS - 1
ER -