Mortality Risk in Patients With Dementia Treated With Antipsychotics Versus Other Psychiatric Medications
Abstract
OBJECTIVE: Mortality rates in the year following new antipsychotic medication starts for neuropsychiatric symptoms of dementia were compared with rates after starts of other psychiatric medications. METHOD: The retrospective, cohort study used national data from the Department of Veterans Affairs (fiscal years 2001-2005) on patients older than 65 years who began outpatient treatment with psychiatric medication following a dementia diagnosis (N=10,615). Twelve-month mortality rates were compared in patients taking antipsychotics and those taking other psychiatric medications. The authors controlled for confounding by using multivariate models and propensity-scoring methods. Secondary analyses included a no-medication group and examination of mortality causes. RESULTS: All groups taking antipsychotics had significantly higher mortality rates (22.6%-29.1%) than patients taking nonantipsychotic medications (14.6%). Adjusted mortality risks for atypicals and for combined atypical and conventional antipsychotics were similar to those for conventional antipsychotics. The mortality risk was significantly lower for nonantipsychotic medications than conventional antipsychotics. Except for anticonvulsants, the adjusted risks for all individual classes of nonantipsychotics were significantly lower than the risk for antipsychotics. Mortality risks did not change over 12 months. The proportions of patients taking antipsychotics who died from cerebrovascular, cardiovascular, or infectious causes were not higher than rates for those taking nonantipsychotic psychiatric medications. CONCLUSIONS: Antipsychotic medications taken by patients with dementia were associated with higher mortality rates than were most other medications used for neuropsychiatric symptoms. The association between mortality and antipsychotics is not well understood and may be due to a direct medication effect or the pathophysiology underlying neuropsychiatric symptoms that prompt antipsychotic use.
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Subsequent observational studies have confirmed concerns about increased mortality in patients with dementia with conventional antipsychotics versus atypical antipsychotics, and atypical antipsychotics versus other psychotropic drugs.
“Subsequent observational studies have confirmed concerns about increased mortality in patients with dementia with conventional antipsychotics versus atypical antipsychotics,121 and atypical antipsychotics versus other psychotropic drugs.122”
From Assessment and management of behavioral and psychological symptoms of dementia (2015) · cites this paper as [122]
The guidelines discuss the risks of use of antipsychotic drugs but do not detail the literature for comparative risk between individual antipsychotics and with other psychotropic drugs.
“In terms of pharmacologic strategies, the guidelines discuss the risks of use of antipsychotic drugs but also do not detail the literature for comparative risk between individual antipsychotics and with other psychotropic drugs.122 126”
From Assessment and management of behavioral and psychological symptoms of dementia (2015) · cites this paper as [122]
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- Authors
- Kales, H. C., Valenstein, M., Kim, H. M., McCarthy, J. F., Ganoczy, D., Cunningham, F., & Blow, F. C.
- Affiliations
- Health Services Research & Development (US)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2007-10
- Volume
- 164
- Issue
- 10
- Pages
- 1568-1576
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2123182031
- Cited by
- 258
- References
- 36
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 8 · 2020: 9 · 2019: 11 · 2018: 15 · 2017: 9 · 2016: 21 · 2015: 22 · 2014: 19 · 2013: 31 · 2012: 21
- FWCI
- 9.66
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- dementia, antipsychotic drugs, mortality risk, neuropsychiatric symptoms, psychiatric medication, atypical antipsychotics, typical antipsychotics, antiepileptic drugs, older adults, veterans, causes of death
- MeSH terms
- Aged, Ambulatory Care, Cause of Death, Cholinesterase Inhibitors, Dementia, Female, Humans, Longitudinal Studies, Male, Psychotropic Drugs, Registries, Risk Factors, Severity of Illness Index, Antipsychotic Agents, United States, United States Department of Veterans Affairs, Cohort Studies, Comorbidity, Survival Analysis
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