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J Am Med Dir Assoc. 2019 Mar;20(3):323-329.e2. doi: 10.1016/j.jamda.2018.12.019.

Antipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study.

Author information

1
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
2
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden.
3
Department of Molecular Medicine and Surgery Stockholm, Karolinska Institutet, Sweden; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
4
Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden.
5
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
6
Theme Aging, Karolinska University Hospital, Huddinge, Sweden; Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
7
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Theme Aging, Karolinska University Hospital, Huddinge, Sweden. Electronic address: dorota.religa@ki.se.

Abstract

OBJECTIVE:

To assess all-cause mortality patients with dementia treated with typical and atypical antipsychotic drugs (APDs).

DESIGN:

Registry-based cohort study.

SETTING AND PARTICIPANTS:

A total of 58,412 patients diagnosed with dementia and registered in the Swedish Dementia Registry were included in the study. Of the study sample, 2526 of the patients were prescribed APDs. Of these, 602 patients were prescribed typical APDs and 1833 patients were prescribed atypical APDs. Ninety-one patients were prescribed both typical and atypical APDs.

MEASUREMENTS:

All-cause mortality based on Swedish Cause of Death Register. Adjusted hazard ratios of mortality were calculated according to class of APDs (typical or atypical) prescribed. Final models were adjusted for age at dementia diagnosis, sex, Charlson comorbidity index, living arrangement, and Mini-Mental State Examination.

RESULTS:

In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3-1.5). After stratifying for dementia types, increased mortality risks associated with APDs were found in patients with Alzheimer's disease, mixed dementia, unspecified dementia, and vascular dementia. Higher risk for mortality was found with typical APDs in patients with mixed and vascular dementia and with atypical APDs in patients with Alzheimer's disease, mixed, unspecified, and vascular dementia. Furthermore, in patients with Alzheimer's disease who had typical APDs, use lower risk of death emerged in comparison with patients with atypical APDs.

CONCLUSIONS/IMPLICATIONS:

Both the use of atypical and typical APDs increased the risk of death in patients with dementia even after adjusting for differences in basic characteristics between groups. Although we cannot rule out the influence of residual confounding, these results would seem to add to studies suggesting caution in APD prescription for patients with dementia.

KEYWORDS:

Alzheimer; Antipsychotics; dementia; mixed dementia; mortality; vascular dementia

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