title: Antipsychotics and mortality in Parkinsonism.
abstract: BACKGROUND
  : The use of antipsychotic medications is associated with an increased risk of death in older adults with dementia. The risk of death in patients with preexisting parkinsonism who receive antipsychotic drugs is not known.
  
  
  METHODS
  : Using a nested case-control design, we examined the risk of death within 30 days of newly starting antipsychotic medications among people with Parkinsonism aged 70 years and older in Ontario, Canada. Data were obtained from Ontario's healthcare administrative databases.
  
  
  RESULTS
  : Among 5,391 individuals with parkinsonism who died during the study period (2002-2008) and a matched comparison group of 25,937 who were still alive, individuals exposed to atypical antipsychotic drugs had a higher risk of death (unadjusted odds ratio [OR] = 2.8, 95% CI: 2.1-3.8, adjusted OR: 2.0, 95% CI: 1.4-2.7). Results were similar for quetiapine use compared with no antipsychotic use (unadjusted OR: 2.5, 95% CI: 1.6-4.0, adjusted OR = 1.8, 95% CI: 1.1-3.0). Typical antipsychotics were associated with an increased odds of death compared with atypical antipsychotics (unadjusted OR = 2.4, 95% CI 1.1-5.2, adjusted OR = 2.4, 95% CI: 1.1-5.7).
  
  
  CONCLUSIONS
  : Individuals with parkinsonism who are newly prescribed antipsychotic medications have a higher risk of death within 30 days than those who do not start these medications. Although it is not possible to establish causality, the results suggest an increased risk. It is important to be vigilant for accompanying serious medical conditions that may increase mortality in individuals requiring treatment with antipsychotics and to consider alternative approaches to treating psychosis, agitation, and aggression in this population.
authors.affiliation: Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, ON, Canada. cmarras@uhnresearch.ca
authors.forename: Connie
authors.initials: C
authors.lastname: Marras
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Hadas
authors.initials: H
authors.lastname: Fischer
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.forename: Christopher
authors.initials: C
authors.lastname: Hyson
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003987:Dibenzothiazepines / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D000077152:Olanzapine; D009864:Ontario / Q000453:epidemiology; D020734:Parkinsonian Disorders / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D012306:Risk; D018967:Risperidone / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D018967:Risperidone; D000077152:Olanzapine