Dementia: Antipsychotic drugs may be overprescribed to treat symptoms

Evan Walker
Evan Walker TheMediTary.Com |
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Experts say agitation and frustration are common in people with dementia. BjelicaS/Getty Images
  • Few medications are available to treat agitation and other psychological and behavioral symptoms of dementia.
  • Antipsychotic medicine can cause stroke or sudden cardiac death.
  • Researchers say people with dementia are likely prescribed antipsychotic drugs too often and inappropriately.

Antipsychotic medications are likely overprescribed and misused in people with Alzheimer’s disease and related dementias who receive home health care.

That’s according to a new study published in the Journal of the American Geriatrics Society, which concludes that this use can lead to worse patient outcomes.

Researchers looked at information on 6,684 adults 65 years and older who received care from a home healthcare agency in New York in 2019.

They reported that people with Alzheimer’s disease or related dementia were more than twice as likely to use antipsychotics than those without – 17% versus about 6%.

Only a few antipsychotic medications have been authorized to treat dementia-related symptoms.

However, some physicians use the drugs off-label to treat symptoms such as agitation, aggression, and psychosis, which are sometimes behavioral and psychological symptoms of dementia.

“Antipsychotics are not considered a first-line treatment for people with dementia with behavioral problems,” said Dr. David Merrill, a geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center in California who was not involved in the study.

“Often, they are rightly prescribed in the hospital after an injury or illness for delirium and confusion, and then they are continued at home. The patient may need support at home, but not more medication,” he added.

“When antipsychotics are prescribed, the doctor should be vigilant on management,” Merrill noted. “For example, taking them off the medications every couple of months to see if they are still needed.”

The study authors reported that older adults with Alzheimer’s or related dementia who experience the following are more likely to be prescribed antipsychotic medication:

  • Limitations in activities of daily living
  • Taking more medications
  • Having behavioral or psychological symptoms
  • Living alone

Antipsychotic medication can have serious adverse effects, such as stroke and sudden cardiac death, when given to older adults with dementia.

“Movement is also a concern,” Merrill said. “Antipsychotics tend to slow a person down and cause rigidness and unsteadiness, increasing the risk of falling.”

The most prescribed antipsychotic reported in the study was quetiapine, a drug approved to help manage symptoms of schizophrenia, bipolar disorder, and major depressive disorder.

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