A majority of elderly patients with dementia develop aggression, delusions, and other neuropsychiatric symptoms during their illness, according to background information in the article. Antipsychotic medications are commonly used to treat these behaviors, along with psychosocial and environmental interventions. During the last decade, newer atypical antipsychotic drugs (i.e., risperidone, olanzapine, quetiapine, and aripiprazole, in order of introduction) have largely replaced the older conventional or first generation antipsychotic drugs (e.g., haloperidol and thioridazine) and have been considered preferred treatments for these behavioral disturbances associated with dementia. However, concerns have arisen about possibly increased risks for cerebrovascular adverse events, rapid cognitive decline, and death with their use.
Lon S. Schneider, M.D., M.S., and colleagues at the University of Southern California, Los Angeles, conducted a meta-analysis of atypical antipsychotic drug trials to assess the evidence for death associated with their use in elderly patients with dementia. After a search of databases and meeting presentations, the researchers selected 15 trials (9 unpublished) that met criteria, generally 10 to 12 weeks in duration, including 16 contrasts of atypical antipsychotic drugs with placebo (aripiprazole [n = 3], olanzapine [n = 5], quetiapine [n = 3], risperidone [n = 5]). A total of 3,353 patients were randomized to study drug and 1,757 were randomized to placebo. Outcomes were assessed using standard methods to calculate odds ratios (ORs) and risk differences based on patients randomized and relative risks based on total exposure to treatment. There were no differences in dropouts.
The researchers found that death occ
Contact: Jon Weiner
JAMA and Archives Journals