Cerebrovascular events among elderly nursing home patients treated with conventional or atypical antipsychotics.
OBJECTIVE
Concern exists about a possible increased risk of cerebrovascular events (CVEs) among elderly patients receiving risperidone or olanzapine. We estimated the effect of atypical and conventional antipsychotics on the risk of CVEs among elderly nursing home patients with dementia.


METHODS
We conducted a case-control study on residents of nursing homes in 6 U.S. states by using the Systematic Assessment of Geriatric drug use via Epidemiology database, which includes data from the Minimum Data Set linked to Medicare inpatient claims. Participants were diagnosed with Alzheimer's disease or other forms of dementia on the basis of clinical criteria and medical history (including medical records and neuroradiologic documentation). Cases included patients hospitalized for stroke or transient ischemic attack between June 30, 1998, and December 27, 1999. For each case, we identified up to 5 controls hospitalized for septicemia or urinary tract infection residing in the same facility during the same time period. The sample consisted of 1130 cases and 3658 controls.


RESULTS
After controlling for potential confounders, the odds ratio of being hospitalized for CVEs was 0.87 (95% CI = 0.67 to 1.12) for risperidone users, 1.32 (95% CI = 0.83 to 2.11) for olanzapine users, 1.57 (95% CI = 0.65 to 3.82) for users of other atypical agents, and 1.24 (95% CI = 0.95 to 1.63) for conventional antipsychotic users compared to nonusers of antipsychotics. A history of CVEs appeared to modify the effect of atypical antipsychotics other than risperidone on the risk of new events.


CONCLUSIONS
Overall, no increased risk of CVEs seems to be conferred by atypical or conventional antipsychotics. Preexisting cerebrovascular risk factors might interact with some atypical antipsychotics to increase the risk of events. These results should be interpreted in light of the limitations of the study and need to be confirmed.
Liperoti
Rosa
R
Centro di Medicina dell'Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Rome, Italy. rosa_liperoti @rm.unicatt.it
Gambassi
Giovanni
G
Lapane
Kate L
KL
Chiang
Claire
C
Pedone
Claudio
C
Mor
Vincent
V
Bernabei
Roberto
R
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000139:chemically induced* / Q000453:epidemiology; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D000077152:Olanzapine; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
D014150:Antipsychotic Agents; D001569:Benzodiazepines; D003024:Clozapine; D000077152:Olanzapine