The Upside of Antipsychotics for Dementia Patients

Antipsychotic reductions may lead to worse symptoms in dementia patients

(RxWiki News) Due to recent findings linking antipsychotic medications to poor health and death in dementia patients, some health policymakers have pushed for limited prescribing. But there may be more to the picture.

A new study from England found that limiting antipsychotic use among dementia patients successfully lowered the rate of death — but only when combined with increased social interaction. Medication reduction alone was linked to worse neuropsychiatric symptoms among these patients.

In an opinion piece about this study, Joel Yager, MD, a professor of psychiatry at the University of Colorado, wrote, "Although benefits might accrue from reducing antipsychotic medications, decisions to initiate reductions have to be made carefully. Risks for significant neuropsychiatric deterioration after medication reduction alone strongly emphasize the need for nonpharmacological interventions — e.g., enhanced social interaction — to reduce harms. Adding exercise wouldn't hurt."

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer's disease is the most common type of dementia. The neuropsychiatric symptoms of dementia can include agitation, delusions and depression, among others.

For this study, researchers looked at 277 patients from 16 UK nursing homes. Of these patients, 18 percent were taking antipsychotics and 87 percent had moderate to severe dementia.

Of the 16 nursing homes, half were randomly assigned to antipsychotic review, increased social interaction and/or exercise for nine months. Most were assigned to more than one of these interventions.

Antipsychotic review conformed to current clinical guidelines that recommend limiting newly initiated antipsychotics to 12 weeks in dementia patients.

These researchers found that combining antipsychotic review with increased social interaction had a strong positive effect on reducing mortality. Antipsychotic review alone was tied to worse neuropsychiatric symptoms among these patients, however.

Exercise was found to reduce neuropsychiatric symptoms but not depression scores or mortality. No intervention was found to have a significant impact on agitation.

This study was published Nov. 20 in the American Journal of Psychiatry.

Information on funding sources and conflicts of interest was not available at the time of publication.

Review Date: 
December 1, 2015