- Antipsychotic medication, used to control behavioral and psychological symptoms of dementia in older people, can have negative side effects and increases the risk of stroke and death.
- Most older people on antipsychotic medication can be successfully weaned off, although some people experience a reoccurrence of their dementia-related symptoms.
Most older adults with dementia can successfully be taken off antipsychotic medications, which have negative side effects and increase the risk of death, finds a new evidence review from The Cochrane Library. The reviewers searched for evidence about the benefit of stopping these medications versus the risk that discontinuing use would result in a reoccurrence of distressing dementia symptoms.
“We have enough evidence to prevent people with dementia and [the behavioral and psychological symptoms of dementia] from experiencing side effects associated with antipsychotic medication. Consequently, withdrawal of chronic antipsychotic medication should be incorporated in daily practice,” said the review’s lead author Tom Declercq, M.D., assistant professor in the department of family practice at Ghent University in Belgium.
Dementia is a condition which causes people to gradually lose cognitive function. People with dementia often develop behavioral symptoms such as agitation, anxiety, screaming, wandering and resisting the care of people working with them. Up to 78 percent of people in nursing homes have dementia and 76 percent experience some behavioral and psychological symptoms of dementia. Antipsychotic medication is often used to treat patients when behavioral treatment to control or lessen these troubling symptoms hasn’t proven effective.
Researchers compared the results of placebo-controlled trials where antipsychotic medications were withdrawn to trials that continued using antipsychotics in people with dementia. Participants included 606 adults who were 65 or older. In seven of the nine studies included in the review, people with dementia who had been treated with antipsychotic medications over a long period of time did not experience a deterioration of their behavior when the medications were withdrawn. However, in two studies, patients experienced a relapse after their antipsychotic medications were discontinued.
Declercq noted, “Unfortunately, it is not clear which patients are eligible for discontinuation of antipsychotic medications without relapse.”
“Based on FDA black box warnings about increased mortality in this patient population, the Center for Medicare Services (CMS) and regulatory agencies dealing with nursing homes are already pushing to reduce antipsychotic use with dementia patients,” added Iqbal “Ike” Ahmed, M.D., clinical professor of psychiatry and geriatric medicine at the University of Hawaii.
Ahmed, who agreed with the review’s findings, said, “It should be emphasized that while behavioral problems in dementia patients should be carefully assessed and treated with non-pharmacologic approaches, some patients may need antipsychotics at least in the short term. Stopping treatment, as two review studies pointed out, may result in some patients worsening with these efforts.” Iqbal added, “That’s why it is important for patients, guardians and families to be involved in discussing the risk and benefits of the use of these agents.”
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The Cochrane Library (http://www.thecochranelibrary.com) contains high quality health care information, including systematic reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions.
Declercq T, Petrovic M, Azermai M, Vander Stichele R, De Sutter AIM, van Driel ML, Christiaens T. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD007726. DOI: 10.1002/14651858.CD007726.pub2.