According to a new study, dementia patients taking antipsychotics have a higher mortality risk. Many health professionals still resort to antipsychotics despite the potential danger of this treatment and the availability of other options like valproic acid, cholinesterase inhibitors and antidepressants.
The study was conducted by a team of scientists from the University of Michigan Medical School and VA Center for Clinical Management Research which used data from the VA national electronic health record system to asses approximately 91,000 veterans older than 65 and suffering from dementia. The results were published in the Journal of the American Medical Association (JAMA).
Lead author of the research Dr. Donovan Maust who is also an assistant professor of Psychiatry at the University of Michigan explained how people don’t understand the changes in behavior and psyche that appear once dementia sets in. The most frequent symptoms are “delusions, hallucinations, agitation and aggression”. He added that these changes can bring many dangerous situations for patients as they can harm themselves, family members or their caregivers.
Besides alternative medication, Maust points out that “non-drug behavioral interventions” should also be taken into consideration. The downside to this alternative is that “they are generally time-intensive with limited mechanisms for reimbursement, so are not widely available”.
The research showed that the risk of antipsychotic therapy rises with the dose. Furthermore, the risk of mortality is higher in newer, more frequently used antipsychotics. Maust found a number of reasons that could explain this phenomenon. One possibility could be the fact that higher doses mean “patients are more sedated, which might lead to more falls or more aspiration.” And if this happens to feeble patients, the event could cause death.
The paper analyzed patients under treatment with haloperidol which had a 3.8% higher mortality risk in comparison to those not using this medication.
Maust’s team considers the “DICE” method of determining and controlling behavioral changes in dementia is more beneficial, although it requires more time in comparison to that needed to write a prescription. This approach implies to first use non-medication methods and it cannot be learnt in medical schools or during residency as it isn’t taught there. This approach also needs encouragement from policy-makers and compensation strategies.
Maust hopes that these findings will use this mortality risk estimate when discussing treatment plans with families.
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