Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications.
OBJECTIVE
Mortality rates in the year following new antipsychotic medication starts for neuropsychiatric symptoms of dementia were compared with rates after starts of other psychiatric medications.


METHODS
The retrospective, cohort study used national data from the Department of Veterans Affairs (fiscal years 2001-2005) on patients older than 65 years who began outpatient treatment with psychiatric medication following a dementia diagnosis (N=10,615). Twelve-month mortality rates were compared in patients taking antipsychotics and those taking other psychiatric medications. The authors controlled for confounding by using multivariate models and propensity-scoring methods. Secondary analyses included a no-medication group and examination of mortality causes.


RESULTS
All groups taking antipsychotics had significantly higher mortality rates (22.6%-29.1%) than patients taking nonantipsychotic medications (14.6%). Adjusted mortality risks for atypicals and for combined atypical and conventional antipsychotics were similar to those for conventional antipsychotics. The mortality risk was significantly lower for nonantipsychotic medications than conventional antipsychotics. Except for anticonvulsants, the adjusted risks for all individual classes of nonantipsychotics were significantly lower than the risk for antipsychotics. Mortality risks did not change over 12 months. The proportions of patients taking antipsychotics who died from cerebrovascular, cardiovascular, or infectious causes were not higher than rates for those taking nonantipsychotic psychiatric medications.


CONCLUSIONS
Antipsychotic medications taken by patients with dementia were associated with higher mortality rates than were most other medications used for neuropsychiatric symptoms. The association between mortality and antipsychotics is not well understood and may be due to a direct medication effect or the pathophysiology underlying neuropsychiatric symptoms that prompt antipsychotic use.
Kales
Helen C
HC
Serious Mental Illness Treatment Research and Evaluation Center, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, Ann Arbor, MI 48109, USA. kales@umich.edu
Valenstein
Marcia
M
Kim
H Myra
HM
McCarthy
John F
JF
Ganoczy
Dara
D
Cunningham
Francesca
F
Blow
Frederic C
FC
D000368:Aged; D000553:Ambulatory Care; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs
D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D011619:Psychotropic Drugs