Older Antipsychotics Can Worsen Alzheimer's

As many as 60 percent of Alzheimer's patients in nursing homes are given antipsychotics - both older neuroleptics and atypicals - to control behavior. But a study has found that the older meds provided no benefit for patients with mild behavioural problems and were associated with a marked deterioration in verbal skills. The research focused on 165 people with advanced Alzheimer's who live in nursing homes in UK cities,

The researchers, from Kings College London and the Universities of Oxford and Newcastle, found the drugs offered no long-term benefit for most patients with mild symptoms of disturbed behavior. But just six months of treatment was enough for patients to show a marked deterioration in verbal fluency. Further preliminary analysis already under way on the data suggests the use of neuroleptics may also increase death rates. The study appears in PLoS, Public Libary of Science Medicine.

The researchers conclude that neuroleptics, with their known safety issues, should not be used as first-line treatment to manage problems such as agitation or aggression. For older dementia patients whose neuropsychiatric symptoms are not helped by meds, the researchers advise caution. More studies are urgently needed to find better solutions to help older patients with dementia who have agitation, aggression, and psychosis. However, of the five drugs studied, one was Risperdal, which is actually a newer atypical.

"It is very clear that even over a six-month period of treatment, there is no benefit from neuroleptics in treating the behaviour in people with Alzheimer's disease when the symptoms are mild," Clive Ballard, a professor at Kings College in London and the lead author, tells the BBC. "For people with more severe behavioural symptoms, balancing the potential benefits against adverse effects is more difficult." Rebecca Wood, of the Alzheimer's Research Trust, adds that the results "are deeply troubling and highlight the urgent need to develop better treatments."

The trust says that neuroleptics should only continue to be prescribed long-term to dementia patients with severe behavioural problems, and then only as a last resort when non-drug methods have been tried and have failed. The neuroleptics used in the study were Melleril, Largactil, Serenace and Stelazine. All of the patients, by the way, had been taking neuroleptics for three months. They either continued on the same medication for a further 12 months, or took a dummy pill.

Neil Hunt, of the Alzheimer's Society, tells the BBC that previous research had also shown that anti-psychotic drugs raised the risk of stroke and death for people with dementia. "This widespread overprescription to people with dementia must stop," he says. "It is time we stop wasting money giving people drug treatments with no benefit and start investing in good quality dementia care."

Hat tip to Pharmagossip