Antipsychotic drugs dementia

McShane R, Keene J, Gedling K et al. (1997) Do neuroleptic drugs hasten cognitive decline in dementia Prospective study with necropsy follow up. BMJ 314(7076) 266-270 Mortimer AM, Shepherd CJ, Rymer M et al. (2005) Primary care use of antipsychotic drugs an audit and intervention study. Ann Gen Psychiatry 4 18 DOI 10.1186/1744-859X-4-18 Mulsant BH, Pollock BG, Kirshner M et al. (2003) Serum anticholinergic activity in a community-based sample of older adults relationship with cognitive performance. Arch Gen Psychiatry 60(2) 198-203... 

Lee PE, Gill SS, Freedman M, et al. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia systematic review. BrMed J 2004 doi 10.H36/bmj.38125.465579.55. 

Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia meta-analysis of randomized placeho-controUed trials. JAMA 2005 294(15) 1934-43. 

As we shall see, pioneers in the use of antipsychotic drugs almost uniformly cited deactivation as the main clinical effect of neuroleptics. Because of this, clinicians often referred to the neuroleptic effect as a chemical lobotomy (Haase, 1959). Bleuler (1978) observed that longterm neuroleptic use also often dampens the vitality and the initiative of the person (p. 301). He concluded, So we see that long-term maintenance with neuroleptics is fraught with some of the same disadvantages that are ascribed to lobotomies (p. 301). Chapter 5 will discuss permanent cognitive impairment and dementia from these drugs. 

Gill, S., Bronskill, S., Normand, S.-L., Anderson, M., Sykora, K., Lam, K., et al. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146, 775-786. 

Health Canada. (2005, June 15). Health Canada advises consumers about important safety information on atypical antipsychotic drugs and dementia. Retrieved from http // www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2005/2005 63 e.html... 

Kolanowski, A., Fick, D., Waller, J., Ahern, F. (2006). Outcomes of antipsychotic drug use in community-dwelling elders with dementia. Archives of Psychiatric Nursing, 20, 217-225. 

Gareri P, Cotroneo A, Lacava R, Seminara G, Marigliano N, Loiacono A, De Sarro G. Comparison of the efficacy of new and conventional antipsychotic drugs in the treatment of behavioral and psychological symptoms of dementia (BPSD). Arch Gerontol Geriatr 2004 Suppl 9 207-15. 

Stroke is a matter of increasing concern with some antipsychotic drugs, and the Canadian Medicine Agency has issued a warning that there is a risk of stroke with risperidone (116). On April 2005, the FDA issued an alert and asked the company to add the following information to both the oral and depot formulations The FDA has found that older patients treated with atypical neuroleptic drugs for dementia had a higher chance for death than patients who did not take the medicine. This is not an approved use (117). In some countries, the use of... 

Imfeld et al. [55] observed that the incidence rates of ischemic stroke for patients with AD, VD, or no dementia were 4.7/1,000 person-years (PYs), 12.8/1,000 PYs, and 5.1/1,000 PYs, respectively. Compared with dementia-free patients, the odds ratio of developing a transitory ischemic attack (TIA) for patients with AD treated with atypical antipsychotic drugs was 4.5. According to these results, patients with VD, but not AD, have a higher risk of developing an ischemic stroke than those without dementia. In patients with AD, but not VD, use of atypical antipsychotic drugs was associated with an increased risk of TIA. 

The beneficial effects of antipsychotic drugs are not limited to schizophrenia. They also are employed in disorders ranging from postsurgical delirium and amphetamine intoxication to paranoia, mania, psychotic depression, and the agitation of Alzheimer s dementia (although their efficacy in this disorder in not proven). They are especially useful in severe depression and possibly in other conditions marked by severe turmoil or agitation. 

Death Deaths associated with commonly prescribed antipsychotic drugs [SEDA-32, 89 SEDA-33, 90] have been assessed in a 5-year retrospective study using US Veterans National Healthcare data [54 ]. The exposed subjects, who were predominantly male, aged 65 and older and with a diagnosis of dementia, were compared with randomly selected controls. Those who were exposed to haloperidol (n = 2217), olanzapine ( = 3384), quetiapine (n = 4277), or risperidone ( = 8249) had more co-morbidities than the controls. During the first 30 days, there was a significant increase in mortality in those who took doses of haloperidol over 1 mg/day (HR=3.2 95% Cl = 2.2, 4.5), olanzapine over 2.5 mg/day (HR = 1.5 95% CI=1.1, 2.0), or risperidone over 1 mg/day... 

Zyprexa. Eli Lilly agreed to pay 1.2 billion to settle more than 28,500 cases brought by patients claiming that it knew that its antipsychotic drug Zyprexa could cause obesity and diabetes, but failed to warn doctors of that fact as they preseribed it for treating many forms of dementia. The drug remains on the market. ... 

Atypical antipsychotics may be helpful in managing the delusions and agitated behavior that can accompany dementia. These medications, include risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), and olanzapine (Zyprexa). All antipsychotics, typical and atypical, appear to increase the risk of death in patients with dementia and psychosis. This appears as a warning in the package inserts of the newer drugs. A prudent approach is to discuss this risk with the caregiver, use the lowest effective dose, and monitor for effectiveness. 

Tourette s syndrome, a heterogeneous behavioral disorder associated with motor and vocal tics of variable form and severity, can be effectively treated with haloperidol. Antipsychotics can also be employed to control disturbed behavior in senile dementia or Alzheimer s disease, since they decrease confusion, agitation, and hyperactivity. Most of these drugs also exhibit a strong antiemetic effect and can sometimes be used clinically for this purpose. 

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