Death Risk for Dementia Patients May Increase with Antipsychotic Use

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Seniors with dementia who take antipsychotics may face a higher risk of death than previously thought.

Seniors with dementia who take antipsychotics may face a higher risk of death than previously thought.

In 2005, the FDA reported clinical trial evidence of an increase in mortality rates when atypical antipsychotic medications were used to treat behavioral disorders in elderly patients with dementia. Of note, olanzapine, risperidone, quetiapine, and all other atypical antipsychotics are not approved by the FDA for this indication.

Donovan Maust, MD, assistant professor in the Department of Psychiatry at the University of Michigan and lead author of a recent study on the topic that was published in JAMA, told Pharmacy Times that dangerous behavior among patients with dementia may prompt the use of antipsychotics, which may be taken to relieve agitation, hallucinations, and delusions.

Dr. Maust and his co-authors examined 90,786 patients aged ≥65 years with dementia and compared the health risks associated with antipsychotics with those linked to no treatment or an alternative psychotropic medication.

Compared with seniors who did not take antipsychotics, elderly patients with dementia who took haloperidol had an increased mortality risk of 3.8%, followed by risperidone at 3.7%, olanzapine at 2.5%, and quetiapine at 2%. Compared with seniors who took antidepressants, mortality risk ranged from 12.3% among haloperidol users to 3.2% among quetiapine users.

Dosage also had an effect on the patients’ mortality risks. In fact, atypical antipsychotics such as olanzapine, quetiapine, and risperidone were associated with a 3.5% greater mortality rate among those who took a higher dose, compared with those taking lower doses.

“Evidence seems to suggest that the risk of mortality accumulates with time as well as with a higher dose (for the atypical antipsychotics), so perhaps the main recommendation would be that, if providers and families have agreed to a trial of an antipsychotic, it is best to minimize the dose and duration of treatment as much as possible,” Dr. Maust told Pharmacy Times.

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