Dementia and antipsychotic medicine: A new review

One in three senior citizens suffer from Alzheimer’s disease or dementia when they die, according to the Alzheimer’s Association. Often patients with dementia have behavioral problems such as agitation, aggression, anxiety and depression. Many times, doctors prescribe antipsychotic medications to control these problems. But their effectiveness is limited and there is concern about side effects, including higher mortality rates with long-term use.

Now there’s a new systematic review by the Cochrane Collaboration that looks at whether it’s possible to stop long-term antipsychotic treatment for dementia patients. The review included nine studies with a total of 606 patients – mostly nursing home residents.

The review found that “older nursing home residents or outpatients with dementia can be withdrawn from long-term antipsychotics without detrimental effects on their behavior.”

The review did find that patients with more severe symptoms might have additional behavioral problems if they stop taking medicine. And it’s not clear if patients who stop taking the medicine have improved intellectual processes or quality of life.

Still, the review recommends taking dementia patients off long-term antipsychotics, especially if their symptoms are not severe. The review also found that more research is needed to identify patients who should stay on antipsychotic medications.

“This is an important finding,” said Dr. Cary Reid, a geriatrician at Weill Cornell Medical College. “We are quick to start these medications in patients with dementia and behavioral problems. Once a patient is on them, the medication are often continued indefinitely without efforts to taper and discontinue them to see whether patients really need them.

“Given the risks associated with this class of medications and substantial costs of the newer antipsychotic medications, efforts should be directed at how best to translate this finding into actionable initiatives,” he said.

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