Study highlights high risk of antipsychotic use in dementia

Some antipsychotic treatments are associated with serious side effects when they are used to relieve symptoms of dementia such as Alzheimer’s disease, a study published Thursday suggests, fueling the already widespread controversy surrounding the drugs.

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

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

But it also happens that they are prescribed to patients suffering from dementia, for example, Alzheimer’s disease. It is not about curing these diseases, which are incurable in most cases, but about calming certain symptoms, such as aggressive behavior.

However, such use is highly controversial due to the serious side effects that these treatments present and their limited effectiveness in this indication.

In France, as in the UK where the BMJ study was conducted, only risperidone and haloperidol are approved for the treatment of dementia.

The BMJ study shows even wider risks of using antipsychotics in dementia than previously thought, including, for example, pneumonia.

This work, carried out by post hoc examination of data from the British health care system, cannot, however, establish a direct cause-and-effect relationship. For example, it is possible that in some cases pneumonia contributed to the development of dementia—and hence the appropriate treatment—rather than the other way around.

But several neurologists and geriatricians praised the seriousness of the methodology and the important nature of such a study at a time when there has been a surge in antipsychotic prescribing in the wake of the Covid crisis.

“The risk is that patients are prescribed dangerous antipsychotics simply because there are not enough trained health professionals to manage their behavior,” neurologist Charles Marshall commented to the British Science Media Center, admitting that such treatment may be justified in rare cases. cases. .