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Antipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden.
Department of Molecular Medicine and Surgery Stockholm, Karolinska Institutet, Sweden; Theme Aging, Karolinska University Hospital, Huddinge, Sweden.
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2019 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, no 3, p. 323-329.e2Article in journal (Refereed) Published
Abstract [en]

Objective

To assess all-cause mortality patients with dementia treated with typical and atypical antipsychotic drugs (APDs).

Design

Registry-based cohort study.

Setting and participants

A total of 58,412 patients diagnosed with dementia and registered in the Swedish Dementia Registry were included in the study. Of the study sample, 2526 of the patients were prescribed APDs. Of these, 602 patients were prescribed typical APDs and 1833 patients were prescribed atypical APDs. Ninety-one patients were prescribed both typical and atypical APDs.

Measurements

All-cause mortality based on Swedish Cause of Death Register. Adjusted hazard ratios of mortality were calculated according to class of APDs (typical or atypical) prescribed. Final models were adjusted for age at dementia diagnosis, sex, Charlson comorbidity index, living arrangement, and Mini-Mental State Examination.

Results

In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3–1.5). After stratifying for dementia types, increased mortality risks associated with APDs were found in patients with Alzheimer's disease, mixed dementia, unspecified dementia, and vascular dementia. Higher risk for mortality was found with typical APDs in patients with mixed and vascular dementia and with atypical APDs in patients with Alzheimer's disease, mixed, unspecified, and vascular dementia. Furthermore, in patients with Alzheimer's disease who had typical APDs, use lower risk of death emerged in comparison with patients with atypical APDs.

Conclusions/Implications

Both the use of atypical and typical APDs increased the risk of death in patients with dementia even after adjusting for differences in basic characteristics between groups. Although we cannot rule out the influence of residual confounding, these results would seem to add to studies suggesting caution in APD prescription for patients with dementia.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 20, no 3, p. 323-329.e2
Keywords [en]
Antipsychotics; dementia; mortality; Alzheimer; vascular dementia; mixed dementia
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:liu:diva-155561DOI: 10.1016/j.jamda.2018.12.019ISI: 000459801300015PubMedID: 30824220Scopus ID: 2-s2.0-85062028520OAI: oai:DiVA.org:liu-155561DiVA, id: diva2:1300677
Note

Funding Agencies|Swedish Brain Power network; Swedish Associations of Local Authorities and Regions; Gun och Bertil Stohnes Stiftelse; CIMED grant; Alzheimerfonden; Swedish Research Council [Drn 2012-2291, Drn 2016-02317]; Stockholm County Council (ALF project)

Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-06-27Bibliographically approved

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Division of Neuro and Inflammation ScienceFaculty of Medicine and Health SciencesDepartment of Acute Internal Medicine and Geriatrics
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