Study highlights high risks of antipsychotics used in dementia

2024-04-18 02:00:22

Several antipsychotic treatments are associated with serious side effects when they are used to calm symptoms of dementia such as Alzheimer’s disease, points out a study published Thursday, fueling the already numerous controversies surrounding these drugs.

“The use of antipsychotics (…) in adults with dementia is associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia and acute renal failure,” lists this study published in the British Medical Journal (BMJ).

These treatments — risperidone, haloperidol, quetiapine and olanzapine — are normally used for psychotic disorders such as schizophrenia. They are also sometimes used against depression that is particularly resistant to other medications.

But it also happens that they are prescribed to patients suffering from dementia, such as Alzheimer’s. It is not a question of curing these illnesses, most of the time incurable, but of calming certain symptoms such as aggressive behavior.

This use is, however, very controversial, due to the serious side effects that these treatments pose, and their limited effectiveness in this indication.

In France, as in the United Kingdom, where the BMJ study was carried out, only risperidone and haloperidol are authorized for dementia.

The BMJ study shows even broader risks of antipsychotics used in dementia than previously considered, including for example pneumonia.

This work, carried out by examining data from the British healthcare system a posteriori, cannot however establish a direct cause and effect relationship. It is, for example, possible that, in certain cases, pneumonia favored the onset of dementia — and therefore the prescription of an associated treatment — and not the other way around.

But several neurologists and geriatricians have praised the seriousness of the methodology and the important nature of such a study, at a time when antipsychotics have seen a resurgence in prescriptions since the Covid crisis.

“The risk is that patients are prescribed dangerous antipsychotics, simply because there are not enough trained healthcare workers to manage their behavior,” commented neurologist Charles Marshall in a reaction to the British Science Media Center, admitting that these treatments may be justified in rare cases.

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