Warning over anti-psychotic drugs
Updated on 09 January 2009
Anti-psychotic drugs can double the risk of death among Alzheimer's patients given the medicines to prevent disturbing and troublesome symptoms, a study has shown.
The findings prompted immediate calls to end over-prescribing of the powerful drugs to elderly people with the most common form of dementia.
Anti-psychotic drugs are normally given to people with serious mental illnesses such as schizophrenia. But they are often also used to reduce some of the most distressing symptoms caused by Alzheimer's, including severe aggression, delusions, and agitation. The drugs are said to offer modest improvements over periods of six to 12 weeks.
However, resorting to the medications to treat Alzheimer's is controversial. Studies have shown that the practice is associated with a range of serious adverse conditions, including Parkinson's-like symptoms, accelerated mental decline, and strokes.
Taking the drugs for several weeks also appears to increase death rates among Alzheimer's patients.
The new research is the first to look at the effect of giving anti-psychotics to Alzheimer's sufferers over long periods of time. It showed that over two years survival rates fell by 35% and after three years the risk of death almost doubled.
Although the health service watchdog the National Institute for health and Clinical Excellence (Nice) recommends that the drugs should only be used in severe cases for short periods, the average length of time they are prescribed for Alzheimer's is one to two years.
In many nursing homes in Europe and North America, up to 30% to 60% of residents with dementia are prescribed anti-psychotics, commonly for longer than a year, the researchers reported.
The findings published online in journal The Lancet Neurology followed a study involving 178 Alzheimer's patients in UK care homes. Half were randomly selected to continue taking anti-psychotic drugs while the other half were switched to an inactive "dummy" placebo. Most of the patients prescribed anti-psychotics were taking risperidone or haloperidol. Over the course of the trial, a total of 76 patients died.
The researchers found that the difference in survival rates between the two groups increased with time. After one year, 77% of the placebo group had survived compared with 70% of those taking anti-psychotics. At two years, survival was 71% for the placebo group and 46% for the anti-psychotic group - a difference of 35%. After three years 59% of the placebo group were still alive compared with just 30% of those being treated with anti-psychotics.
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