Psychotic Symptoms, Not Antipsychotic Medication, Linked to Institutionalization, Death in Alzheimer's Patients

It is the presence of psychiatric symptoms, including psychosis and agitation, not the use of antipsychotic medications that appears to raise the risk for institutionalization or death among patients with Alzheimer’s disease (AD), according to a new study published in AJP in Advance.

Researchers at several institutions, led by Oscar Lopez, M.D., of the University of Pittsburgh, examined time to nursing home admission and time to death in nearly 1,000 patients with a diagnosis of probable AD, taking into account a range of variables, including dementia severity, physical illnesses, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use. A total of 241 patients (25 percent) were exposed to antipsychotics at some time during follow-up. A higher proportion of patients exposed to antipsychotic medications, especially conventional antipsychotics, were admitted to a nursing home or died compared with those who never took these medications, but the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death.

“This observational study does not support the association between mortality and antipsychotic use that has been reported in institutionalized elderly patients,” the researchers stated.

Geriatric psychiatrist and immediate past APA President Dilip Jeste, M.D., who reviewed the study, called it “an important contribution to the literature on mortality related to psychosis and antipsychotics in persons with Alzheimer’s disease," noting that “The results from various published studies have often been at variance with one another. The present study’s finding that psychosis itself is associated with increased mortality is consistent with several other reports, suggesting the need to treat these symptoms. Although there are no FDA-approved safe and effective treatments for psychosis in dementia, a number of pharmacological and psychosocial approaches are available. The treating clinician needs to take into account the risk-benefit ratios for various treatments as well as no specific treatment.”

For more information about AD, see American Psychiatric Publishing's Clinical Manual of Alzheimer Disease and Other Dementias here and Psychiatric News here.

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