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To Prescribe or Not to Prescribe? Atypical Antipsychotic Drugs in Patients with Dementia

Dilip V. Jeste, MD, Thomas Meeks, MD
Volume: 100 Issue: 10 October, 2007

Abstract:

Antipsychotic Drug Use and Mortality in Older Adults with Dementia


Gill SS, Bronskill SE, Normand ST, et al. Ann Intern Med 2007;146:775–786.


Recent data regarding strokes and mortality associated with atypical antipsychotic medications in older adults with dementia have caused considerable confusion and anxiety among patients and their families, clinicians, and researchers. This is an issue of clear public health significance. An estimated 4.5 million Americans have Alzheimer disease, and millions more have other forms of dementia.1 Psychosis affects about 40% of persons with Alzheimer disease,2 while up to 80% of dementia patients exhibit agitation.3 The consequences of these neuropsychiatric syndromes of dementia can include reduced quality of life for the patients, increased caregiver burden, a greater likelihood of patient institutionalization, and soaring medical costs; some studies also suggest an association of psychosis with more rapid clinical deterioration, and possibly death.4

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References:

1. Hebert LE, Scherr PA, Bienias JL, et al. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol 2003;60:1119–1122.
 
2. Ropacki SA, Jeste DV. Epidemiology of and risk factors for psychosis of Alzheimer’s disease: a review of 55 studies published from 1990 to 2003. Am J Psychiatry 2005;162:2022–2030.
 
3. Jeste DV, Meeks TW, Kim DS, et al. Research agenda for DSM-V: diagnostic categories and criteria for neuropsychiatry syndromes in dementia. J Geriatr Psychiatry Neurol 2006;19:160–171.
 
4. Jeste DV, Blazer D, Casey DE, et al. ACNP White Paper on the use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology 2007; Jul 18, EPub ahead of print.
 
5. Weiss E, Hummer M, Koller D, et al. Off-label use of antipsychotic drugs. J Clin Psychopharmacol 2000;20:695–698.
 
6. Jeste DV, Rockwell E, Harris MJ, et al. Conventional versus newer antipsychotics in elderly patients. Am J Geriatr Psychiatry 1999;7:70–76.
 
7. Schneider LS, Dagerman K, Insel PS. Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 2006;14:191–210.
 
8. Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review and critique. Am J Geriatr Psychiatry 2001;9:361–381.
 
9. Livingston G, Johnston K, Katona C, et al. Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. Am J Psychiatry 2005;162:1996–2021.
 
10. Wang PS, Schneeweiss S, Avorn J, et al. Risk of death in elderly users of conventional vs atypical antipsychotic medications. N Engl J Med 2005;353:2335–2341.
 
11. Nasrallah HA, White T, Nasrallah AT. Lower mortality in geriatric patients receiving risperidone and olanzapine versus haloperidol: preliminary analysis of retrospective data. Am J Geriatr Psychiatry 2004;12:437–439.
 
12. Gill SS, Bronskill SE, Normand ST, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med 2007;146:775–786.
 
13. Shakespeare W. The Life of Henry the Fifth. Boston, DC Heath & Co, 1896.

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