Research led by the University of Rochester shows antipsychotics are frequently given to patients with Alzheimer’s disease and related dementias and that use of such drugs is linked to reduced physical improvement in these individuals.
“Antipsychotic use in persons with dementia is a serious patient safety issue, and it should be regularly reviewed for opportunities of deprescribing—such as dose reduction until discontinuation—whenever possible,” said Jinjiao Wang, an assistant professor at the University of Rochester School of Nursing, who led the research in a press statement.
Antipsychotics are not approved to treat patients with Alzheimer’s or other dementias, but are frequently used “off-label” by healthcare professionals to manage some of the behavioral and psychological symptoms of these conditions.
“Abundant evidence shows that antipsychotics are often prescribed without appropriate indicators or long past the initial indication,” write the authors in the Journal of the American Geriatrics Society. “Furthermore, antipsychotics have considerable risk of serious drug-related adverse events, especially stroke and sudden cardiac death among older adults with Alzheimer’s or other dementias.”
The study authors collected data in a real-life setting from 6684 older individuals (aged 65 years or older) receiving home health care in New York in 2019. Of this group, 889 had Alzheimer’s or other dementias and 5795 did not.
Use of antipsychotic medication in the dementia and control group was 17.2% and 6.6%, respectively. Factors predicting antipsychotic prescription in the dementia group included: having a lower composite activities of daily living (ADL) score, having a higher total number of medications and having behavioral and psychological symptoms. Those that lived alone were less likely to be given antipsychotics.
“Living alone may reflect a healthier and more independent ADL profile… that enables the person to live alone, which are associated with a lower need for antipsychotics. Additionally, without a caregiver living at home, there may be fewer “requests” of the caregiver to the prescribers to “do something” to address challenging Alzheimer’s or other dementia symptoms, leading to lower prescribing of antipsychotics,” write the authors.
Notably, use of antipsychotics in the dementia group was linked to less improvement in the ADL score (average change of 2.61) at the end of the study period than those not being treated with these drugs (average change of 3.46).
“Prior evidence has shown that antipsychotic use increases the risk of all-cause mortality among community-dwelling older adults with Alzheimer’s or other dementias. When used in patients living with [these conditions], antipsychotic use can also cause confusion, memory loss, and reduce mobility and strength, which may make it more challenging for one to improve in ADL function,” conclude the authors.
“As such, it is not surprising that patients living with ADRD who were taking antipsychotics experienced less improvement in ADLs than nonantipsychotic users in this study, which was in alignment with our hypothesis.”
