title: Association between prescription of conventional or atypical antipsychotic drugs and mortality in older persons with Alzheimer's disease.
abstract: OBJECTIVE
  To evaluate whether dementia patients prescribed antipsychotic drugs have a higher mortality compared to unexposed patients, and to investigate whether there are differences in mortality associated with exposure to conventional versus atypical antipsychotic drugs.
  
  
  METHODS
  Retrospective population cohort study with information gathered from the Italian Health Information System. All 4,369 residents of Milan (Italy) aged 60 years or older who were newly prescribed an antidementia drug (donepezil, rivastigmine or galantamine) from January 2002 to June 2008 were included. All new users of antipsychotic drugs in this cohort were categorized according to conventional (n = 156) or atypical (n = 806) drug exposure. The mortality risks of users of conventional or atypical antipsychotics compared to nonusers were evaluated with survival analysis, considering exposure to antipsychotic drugs as a time-dependent variable.
  
  
  RESULTS
  Mortality was increased two- and fivefold in users of atypical and conventional antipsychotics, respectively, with respect to nonusers.
  
  
  CONCLUSIONS
  Dementia patients prescribed antipsychotic drugs had a higher risk of death. This risk was highest for those prescribed conventional antipsychotics. At least part of the excess mortality may be due to the underlying neuropsychiatric symptoms that prompted the use of antipsychotics rather than a direct medication effect.
authors.affiliation: Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, Segrate, Italy. m.musicco@hsantalucia.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Musicco
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.forename: Fulvio
authors.initials: F
authors.lastname: Adorni
authors.forename: Carla
authors.initials: C
authors.lastname: Pettenati
authors.forename: Luigi
authors.initials: L
authors.lastname: Bisanti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000401:mortality*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D001526:Behavioral Symptoms / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors