Antipsychotic Use Associated with Multiple Adverse Outcomes in Dementia Patients

Antipsychotic use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, according to study results published in The BMJ. Previous studies established increased risks of stroke and sudden cardiac death in individuals taking antipsychotics. Despite these safety concerns, antipsychotics are commonly prescribed for managing behavioral and psychological symptoms in people diagnosed with dementia. The results of this study demonstrate additional harms associated with the use of antipsychotics and underscore the need for regular treatment plan reviews with patients and caregivers to reassess the need for their continued use.

The population-based matched cohort study included adults ≥50 years diagnosed with dementia between 1998 and 2018 (N=173,910). Each new antipsychotic user (n=35,339) was matched with up to 15 non-users using incidence density sampling. Researchers utilized linked primary care, hospital, and mortality data from the Clinical Practice Research Datalink in England to investigate the risks of adverse outcomes associated with antipsychotic use in patients with dementia. The primary outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use.

Compared to non-use, current antipsychotic use (within 90 days of a prescription) was associated with elevated risks of the following:

• Pneumonia (hazard ratio [HR], 2.19; 95% CI, 2.10 to 2.28)
• Acute kidney injury (HR, 1.72; 95% CI, 1.61 to 1.84)
• Venous thromboembolism (HR, 1.62; 95% CI,1.46 to 1.80)
• Stroke (HR 1.61; 95% CI, 1.52 to 1.71)
• Fracture (HR, 1.43; 95% CI, 1.35 to 1.52)
• Myocardial infarction (HR, 1.28; 95% CI, 1.15 to 1.42)
• Heart failure (HR, 1.27; 95% CI, 1.18 to 1.37)

In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in matched non-users.