Antipsychotic medications such as risperidone, olanzapine and aripiprazole are used to treat psychological and behavioural symptoms among dementia patients. Current evidence indicate prescription rates for antipsychotics vary and wider consensus to evaluate clinical epidemiological outcomes is limited.
To investigate the potential impact of atypical antipsychotics on the mortality of patients with dementia.
A retrospective clinical cohort study was developed to review United Kingdom Clinical Record Interactive Search system based data between January 1, 2013 to December 31, 2017. A descriptive statistical method was used to analyse the data. Mini Mental State Examination (MMSE) scores were used to assess the severity and stage of disease progression. A cox proportional hazards model was developed to evaluate the relationship between survival following diagnosis and other variables.
A total of 1692 patients were identified using natural language processing of which, 587 were prescribed olanzapine, quetiapine or risperidone (common group) whilst 893 (control group) were not prescribed any antipsychotics. Patients prescribed olanzapine showed an increased risk of death [hazard ratio (HR) = 1.32; 95% confidence interval (CI): 1.08-1.60; P < 0.01], as did those with risperidone (HR = 1.35; 95%CI: 1.18-1.54; P < 0.001). Patients prescribed quetiapine showed no significant association (HR = 1.09; 95%CI: 0.90-1.34; P = 0.38). Factors associated with a lower risk of death were: High MMSE score at diagnosis (HR = 0.72; 95%CI: 0.62-0.83; P < 0.001), identifying as female (HR = 0.73; 95%CI: 0.64-0.82; P < 0.001), and being of a White-British ethnic group (HR = 0.82; 95%CI: 0.72-0.94; P < 0.01).
A significant mortality risk was identified among those prescribed olanzapine and risperidone which contradicts previous findings although the study designs used were different. Comprehensive research should be conducted to better assess clinical epidemiological outcomes associated with diagnosis and therapies to improve clinical management of these patients.
Core Tip: Antipsychotic medication is widely prescribed to patients with dementia displaying neuropsychiatric symptoms. Treatment with olanzapine and risperidone was associated with an increased mortality risk. In comparison, quetiapine showed a relatively lower, non-significant association with the mortality risk in those with dementia. Clinicians need to be aware of the potential heterogeneous relationship between dementias, antipsychotic medication, and mortality when creating a psychopharmacological treatment plan for their patients.
Citation: Phiri P, Engelthaler T, Carr H, Delanerolle G, Holmes C, Rathod S. Associated mortality risk of atypical antipsychotic medication in individuals with dementia. World J Psychiatry 2022; 12(2): 298-307
DOI: https://dx.doi.org/10.5498/wjp.v12.i2.298<br/ ><br/ >Phiri P, Engelthaler T, Carr H, Delanerolle G, Holmes C, Rathod S. Associated mortality risk of atypical antipsychotic medication in individuals with dementia. World J Psychiatry 2022; 12(2): 298-307 [DOI: 10.5498/wjp.v12.i2.298]
Article in press: January 17, 2022
Published online: February 19, 2022