One of the many troubling symptoms of Alzheimer’s disease (AD) is that patients often become agitated, delusional and aggressive. An increasingly common solution has been to calm this behavior with an array of antipsychotic medications, including risperidone. Evidence is beginning to emerge that not only may this be not particularly helpful, it may actually be causing patients to die sooner.
Antipsychotic drugs have been evaluated for Alzheimer’s patients on a short-term (generally under three months) basis, but the reality is that many patients stay on them for a year or even two. Researchers have explored whether their adverse effects offset advantages or indeed whether they are of any benefit at all — with one study showing that some AD patients taking antipsychotics actually experienced faster cognitive decline. Now a new study from the UK shows that keeping AD patients on these drugs for extended periods is associated with higher mortality, due to serious adverse events. The study, from King’s College London, evaluated 165 AD patients and found that those who remained on antipsychotic drugs one year or longer were significantly more likely to die than those who were switched to a placebo. There was no difference in mortality after six months on the drugs, but patients taking the drugs three years or longer had only about a one-third chance of still being alive, compared with about two-thirds for those taking placebo.
I contacted the study author, Clive Ballard, professor of age-related disease at King’s College London, to find out more about the risk of these drugs. These patients had either moderately severe or severe AD, he told me, noting that the increased mortality risk was related to side effects of the drugs, including increased sedation and infections. Dr. Ballard adds that while there may be modest benefits to using these drugs short-term, there is no evidence that long-term outcome is improved. A better solution for patients with disturbing and disruptive behavior is to improve staff training and offer psychological interventions. More research on safer drug treatments is also needed.
