The Long-Term Effects of Conventional and Atypical Antipsychotics in Patients With Probable Alzheimer’s Disease
Year: 2013
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: The authors sought to determine the effects of conventional and atypical antipsychotic use on time to nursing home admission and time to death in a group of outpatients with mild to moderate probable Alzheimer's disease. METHOD: The authors examined time to nursing home admission and time to death in 957 patients with the diagnosis of probable Alzheimer's disease who had at least one follow-up evaluation (mean follow-up time, 4.3 years [SD=2.7]; range, 0.78-18.0 years) using Cox proportional hazard models adjusted for age, gender, education level, dementia severity, hypertension, diabetes mellitus, heart disease, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use. RESULTS: A total of 241 patients (25%) were exposed to antipsychotics at some time during follow-up (conventional, N=138; atypical, N=95; both, N=8). Nursing home admission (63% compared with 23%) and death (69% compared with 34%) were more frequent in individuals taking conventional than atypical antipsychotics. In a model that included demographic and cognitive variables, hypertension, diabetes mellitus, heart disease, incident strokes, and extrapyramidal signs, only conventional antipsychotic use was associated with time to nursing home admission. However, the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death. CONCLUSIONS: The use of antipsychotic medications, both conventional and atypical, was not associated with either time to nursing home admission or time to death after adjustment for relevant covariates. Rather, it was the presence of psychiatric symptoms, including psychosis and agitation, that was linked to increased risk of institutionalization and death after adjustment for exposure to antipsychotics.
Source: American Journal of Psychiatry
Institutions: University of Pittsburgh, University of Virginia
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, H. Lundbeck A/S, National Institutes of Health, National Institute on Aging, National Institute of Mental Health, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1418851800, AGE-RELATED CHANGES IN SYNAPTIC DENSITY, The role of astrogliosis in aging and the pathological and clinical progression of Alzheimer's Disease, G236442059, G239451354, ACISR for Late-Life Depression Prevention, G2495783792, G2640555407, G274585943, Roles of Gray Matter Brain Aging and Small Vessel Disease in AD Pathophysiology, Alzheimer's Disease Research Center, G3544262812, Neurobiology of Mild Cognitive Impairment in the Elderly, G3880778400, Predictors of Alheimers Disease in Mild Cognitive Impairment, G4796589941, University of Pittsburgh Clinical and Translational Science Institute, Predictors of Alzheimers Disease in Mild Cognitive Impairment, Perinatal choline therapy in a mouse model of Down Syndrome & Alzheimer's Disease, Cellular and Molecular Medial Temporal Lobe Pathology in Elderly PreMCI subjects, Prediction of Psychosis in Alzheimer Disease, Amyloid-Lowering Small Molecule AB-Binding Agents in AD, G7011886869, G707218699, Cognitive Complaints and Decline and B-Amyloid Deposition in Non-Demented Elderly, AMYLOID PATHOLOGY AND COGNITION IN NORMAL ELDERLY, COGNITIVE TESTS, APOE, BRAIN MRI AND RISKS OF DEMENTIA, Roles of Gray Matter Brain Aging and Small Vessel Disease in AD Pathophysiology
OpenAlex ID: W2106989122