title: The long-term effects of conventional and atypical antipsychotics in patients with probable Alzheimer's disease.
abstract: OBJECTIVE
  The authors sought to determine the effects of conventional and atypical antipsychotic use on time to nursing home admission and time to death in a group of outpatients with mild to moderate probable Alzheimer's disease.
  
  
  METHODS
  The authors examined time to nursing home admission and time to death in 957 patients with the diagnosis of probable Alzheimer's disease who had at least one follow-up evaluation (mean follow-up time, 4.3 years [SD=2.7]; range, 0.78-18.0 years) using Cox proportional hazard models adjusted for age, gender, education level, dementia severity, hypertension, diabetes mellitus, heart disease, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use.
  
  
  RESULTS
  A total of 241 patients (25%) were exposed to antipsychotics at some time during follow-up (conventional, N=138; atypical, N=95; both, N=8). Nursing home admission (63% compared with 23%) and death (69% compared with 34%) were more frequent in individuals taking conventional than atypical antipsychotics. In a model that included demographic and cognitive variables, hypertension, diabetes mellitus, heart disease, incident strokes, and extrapyramidal signs, only conventional antipsychotic use was associated with time to nursing home admission. However, the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death.
  
  
  CONCLUSIONS
  The use of antipsychotic medications, both conventional and atypical, was not associated with either time to nursing home admission or time to death after adjustment for relevant covariates. Rather, it was the presence of psychiatric symptoms, including psychosis and agitation, that was linked to increased risk of institutionalization and death after adjustment for exposure to antipsychotics.
authors.forename: Oscar L
authors.initials: OL
authors.lastname: Lopez
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
authors.forename: Yue-Fang
authors.initials: YF
authors.lastname: Chang
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sweet
authors.forename: Howard
authors.initials: H
authors.lastname: Aizenstein
authors.forename: Beth
authors.initials: B
authors.lastname: Snitz
authors.forename: Judith
authors.initials: J
authors.lastname: Saxton
authors.forename: Eric
authors.initials: E
authors.lastname: McDade
authors.forename: M Ilyas
authors.initials: MI
authors.lastname: Kamboh
authors.forename: Steven T
authors.initials: ST
authors.lastname: DeKosky
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: William E
authors.initials: WE
authors.lastname: Klunk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D015897:Comorbidity; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D016743:Mental Competency; D009026:Mortality; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000209:etiology; D012307:Risk Factors; D013995:Time; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
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