Effect of antipsychotics on mortality in elderly patients with dementia: a 1-year prospective study in a nursing home.
OBJECTIVE
The use of risperidone or olanzapine to treat behavioral problems associated with dementia is no longer recommended in the U.K. because of the increased risk of cerebrovascular adverse effects (CVAEs) and/or mortality. To evaluate the risks and benefits of antipsychotics, we measured the rate of mortality in patients with dementia, Alzheimer's disease (AD) and vascular/mixed dementia and compared mortality rates between those who had received antipsychotics and those who had not received antipsychotics.


METHODS
A total of 273 subjects were assessed at baseline, 6 months and 12 months using a 1-year prospective follow-up design. Mortality rates between groups were compared using a Kaplan-Meier curve and log-rank statistics. Relative risks (RRs) were examined by the Cox proportional-hazards model.


RESULTS
The overall 1-year mortality rate in dementia was 23.8%. The mortality rate in those who had not received antipsychotics (26.8%) was higher than that in those who had received antipsychotics (20.6%). RR and 95% confidence interval (CI) of mortality, when we compared those who had not received antipsychotics with those who had received antipsychotics, was 1.277 (95% CI 1.134-1.437) after controlling for age, severity of dementia, medical comorbidities, cognitive impairment (measured by the Korean version of the Mini-mental State Examination (MMSE)) and behavioral and psychological symptoms of dementia (BPSD), measured by the Behavioral Pathology in Alzheimer's Disease Rating Scale, Korean version (BEHAVE-AD-K). When those who had not received antipsychotics were compared with those who had received both risperidone and haloperidol, RR (95% CI) was 1.225 (1.101-1.364).


CONCLUSIONS
This study does not support reports that antipsychotics increase mortality in dementia.
Suh
Guk-Hee
GH
Department of Psychiatry, Hallym University Medical Center, Hangang Sacred Heart Hospital, Seoul, Korea. suhgh@chollian.net
Shah
Ajit
A
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000401:mortality*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016001:Confidence Intervals; D015140:Dementia, Vascular / Q000188:drug therapy* / Q000401:mortality*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects; D006707:Homes for the Aged; D006801:Humans; D007723:Korea; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000401:mortality*; D008609:Mental Status Schedule; D009735:Nursing Homes; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects; D016019:Survival Analysis
D014150:Antipsychotic Agents; D006220:Haloperidol; D018967:Risperidone