Effect of antipsychotics on mortality in elderly patients with dementia: a 1-year prospective study in a nursing home
Background and objectives: The use of risperidone or olanzapine to treat behavioral problems associated with dementia is no longer recommended in the U.K. because of the increased risk of cerebrovascular adverse effects (CVAEs) and/or mortality. To evaluate the risks and benefits of antipsychotics, we measured the rate of mortality in patients with dementia, Alzheimer's disease (AD) and vascular/mixed dementia and compared mortality rates between those who had received antipsychotics and those who had not received antipsychotics.
Methods: A total of 273 subjects were assessed at baseline, 6 months and 12 months using a 1-year prospective follow-up design. Mortality rates between groups were compared using a Kaplan–Meier curve and log-rank statistics. Relative risks (RRs) were examined by the Cox proportional-hazards model.
Results: The overall 1-year mortality rate in dementia was 23.8%. The mortality rate in those who had not received antipsychotics (26.8%) was higher than that in those who had received antipsychotics (20.6%). RR and 95% confidence interval (CI) of mortality, when we compared those who had not received antipsychotics with those who had received antipsychotics, was 1.277 (95% CI 1.134–1.437) after controlling for age, severity of dementia, medical comorbidities, cognitive impairment (measured by the Korean version of the Mini-mental State Examination (MMSE)) and behavioral and psychological symptoms of dementia (BPSD), measured by the Behavioral Pathology in Alzheimer's Disease Rating Scale, Korean version (BEHAVE-AD-K). When those who had not received antipsychotics were compared with those who had received both risperidone and haloperidol, RR (95% CI) was 1.225 (1.101–1.364).
Conclusion: This study does not support reports that antipsychotics increase mortality in dementia.(Published Online September 14 2005)
(Received May 14 2004)
(returned for revision June 18 2004)
(revised version received June 23 2004)
(Accepted June 24 2004)
Key Words: mortality; dementia; Alzheimer's disease; vascular dementia; risperidone; haloperidol; risk.
c1 Correspondence should be addressed to: Guk-Hee Suh, Department of Psychiatry, Hallym University College of Medicine, Hangang Sacred Heart Hospital, 94-200 Yungdungpo-Dong, 150-030 Seoul, Korea. Phone: +82 2 2639 5483; Fax: +82 2 2677 9095. Email: firstname.lastname@example.org.