Abstract: Back to table of contents Previous article Next article Letter to the EditorFull AccessPsychotropic Medication and Stroke OutcomeMINNA M. RAIVIO, M.D., JOUKO V. LAURILA, M.D., Ph.D., TIMO E. STRANDBERG, M.D., Ph.D., REIJO S. TILVIS, M.D., Ph.D., and KAISU H. PITKÄLÄ, M.D., Ph.D., MINNA M. RAIVIO, M.D., JOUKO V. LAURILA, M.D., Ph.D., TIMO E. STRANDBERG, M.D., Ph.D., REIJO S. TILVIS, M.D., Ph.D., and KAISU H. PITKÄLÄ, M.D., Ph.D., Lahti, FinlandPublished Online:1 May 2005https://doi.org/10.1176/appi.ajp.162.5.1027AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Dr. Herrmann et al. reported a retrospective study concerning the risk of stroke among 11,400 patients (age >66 years) who were administered atypical antipsychotics. Use of atypical antipsychotics was not associated with an elevated risk of stroke compared with use of conventional neuroleptics.We examined the 2-year risk of death among dementia patients who were using atypical antipsychotics or conventional neuroleptics or were nonusers. Originally, 425 patients (age >69 years) in city hospitals and nursing homes in Helsinki, Finland, participated (1); 255 had dementia and 106 had delirium, according to DSM-IV criteria.One hundred thirty-five (52.9%) of 255 patients were given antipsychotics at baseline, 40.4% took conventional neuroleptics, and 12.5% took atypical antipsychotics. After 2 years, 118 of 255 were deceased. The death rate was 47.6% among those taking conventional antipsychotics, 21.9% among those taking atypical antipsychotics, and 50.0% among nonusers. We performed a logistic regression analysis to clarify which factors had independent prognostic value in mortality. When we entered age, gender, severe stage of dementia (clinical dementia rating=2–3), delirium, high number of comorbidities, impaired physical functioning, use of neuroleptics, use of atypical antipsychotics, and use of restraints into the model, only old age (>85 years) (odds ratio=1.71, 95% confidence interval [CI]=1.00–2.95), high number of comorbid disorders (odds ratio=1.96, 95% CI=1.03–3.73), and use of restraints (odds ratio=2.45, 95% CI=1.06–5.65) predicted mortality. It is surprising that the use of atypical antipsychotics seemed to protect against death (odds ratio=0.40, 95% CI=0.17–0.96). Conventional neuroleptics did not have any effect.There is a concern that atypical antipsychotics increase the risk of stroke among dementia patients. In the study by Dr. Herrmann et al., there was no evidence of that. Nevertheless, the study also consisted of people without dementia. Patients with dementia are often old and frail and have comorbidities and delirious episodes with acute illnesses that possibly explain the high risk of death. They also have behavioral symptoms that are frightening for the patient and caregiver. These symptoms are the most common reason for admittance to permanent institutional care (1). Thus, these patients urgently need control for their symptoms. There are several randomized trials showing that both atypical antipsychotics and cholinesterase inhibitors are efficient in controlling these symptoms (1). The use of the cholinesterase inhibitors was quite rare—only 3%—among our participants in 1999–2000. Most patients used conventional neuroleptics. To our knowledge, there are no studies concerning the risk of taking neuroleptics among dementia patients. Our study presents that possibility.It is possible that in our group the frailest patients were administered neuroleptics and the fittest were given atypical antipsychotics even though it would be against any recommendations. Nevertheless, our logistic regression analysis took into account comorbidities, physical functioning, age, and stage of dementia. Rather than showing an elevated risk, atypical antipsychotics had a protective effect.Reference1. Pitkälä KH, Laurila JV, Strandberg TE, Tilvis RS: Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards. Int Psychogeriatr 2004; 16:61–74Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byReview: Risk of Cerebrovascular Adverse Events and Death in Elderly Patients With Dementia When Treated With Antipsychotic Medications: A Literature Review of Evidence31 January 2011 | American Journal of Alzheimer's Disease & Other Dementiasr, Vol. 26, No. 1Journal of the American Geriatrics Society, Vol. 59, No. 7Clinical practice guidelines for severe Alzheimer's disease18 September 2007 | Alzheimer's & Dementia, Vol. 3, No. 4Pharmacologic Management of Neuropsychiatric Symptoms of Alzheimer Disease1 September 2007 | The Canadian Journal of Psychiatry, Vol. 52, No. 10Managing delirium in hospitalized elderly patientsFuture Neurology, Vol. 2, No. 3The American Journal of Geriatric Psychiatry, Vol. 15, No. 5Drug Safety, Vol. 29, No. 10Drugs & Aging, Vol. 22, No. 9 Volume 162Issue 5 May 2005Pages 1027-1027 Metrics PDF download History Published online 1 May 2005 Published in print 1 May 2005
Publication Year: 2005
Publication Date: 2005-05-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 9
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