Antipsychotics and the risk of cerebrovascular accident: a systematic review and meta-analysis of observational studies
Open accessAbstract
Background Studies investigating the association between antipsychotic use and the risk of cerebrovascular accident (CVA) showed inconsistent results.Aim Conduct a systematic review and meta-analysis to evaluate whether use of antipsychotics is associated with increased risk of CVA.Methods Major electronic databases were searched from 1970 to October 2016 for observational studies investigating the risk of CVA among users of antipsychotics. Pooled estimates of odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by random effects meta-analysis.Results Of 1171 citations identified, 10 studies were considered eligible. Significant increase in risk of CVA was associated with first-generation antipsychotics (OR 1.49; 95% CI 1.24-1.77) but not with second-generation antipsychotics (OR 1.31; 95% CI 0.74-2.30). Use of any antipsychotics in patients with dementia was associated with a low risk of CVA (OR 1.17; 95% CI 1.08-1.26).Conclusions The available evidence suggests use of with first-generation antipsychotics as opposed to second-generation antipsychotics significantly increased the risk of CVA.
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In older adults, psychotropic use has been associated with risk of severe adverse effects such as falls, stroke and mortality.
“In older adults, psychotropic use has been associated with the risk of severe adverse effects such as falls [13–18], stroke [17, 19–22] and mortality [13, 23–25].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [19]
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Patra, A., Kamalakannan, S., Pant, H. B., Agiwal, V., Nirupama, A. Y., Chaudhuri, S., & Murthy, G. V. S. (2023) · Journal of Stroke Medicine · doi:10.1177/25166085231186492
Psychotic Disorder after Left Posterior Cerebral Artery Stroke-An Atypical Event.
Nascimento, H., & Almeida, B. (2024) · Actas Españolas de Psiquiatría
Adjunctive treatment of behavioral disorders in patients with cognitive deficit
Tašková, I. (2025) · Česká a slovenská farmacie · doi:10.36290/csf.2024.043
Dementia and Mild Cognitive Impairment
Ellett, L. M. K., Cross, A. J., & Tan, E. C. K. (2025) · Advanced clinical pharmacy - research, development and practical applications/Advanced clinical pharmacy - research, development and practical applications · doi:10.1007/978-3-031-77314-3_9
- Authors
- Hsu, W.-T., Esmaily-Fard, A., Lai, C.-C., Zala, D., Lee, S.-H., Chang, S.-S., & Lee, C.-C.
- Affiliations
- National Taiwan University Hospital (TW)
- The University of Texas MD Anderson Cancer Center (US)
- Chi Mei Medical Center (TW)
- King's College London (GB)
- Chang Gung University (TW)
- Corresponding author
- Lee, Chien-Chang
- Venue
- Journal of the American Medical Directors Association
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 18
- Issue
- 8
- Pages
- 692-699
- ISSN
- 1525-8610 (ISSN-L)
- OpenAlex
- W2606310353
- Cited by
- 59
- References
- 44
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 11 · 2019: 10 · 2018: 5 · 2017: 2
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Journal of the American Medical Directors Association (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- antipsychotic drugs, stroke, stroke risk, typical antipsychotics, atypical antipsychotics, dementia, adverse drug reactions
- MeSH terms
- Dementia, Humans, Antipsychotic Agents, Odds Ratio, Databases, Factual, Risk Assessment, Stroke
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