What Is the Relationship between Antipsychotics and Dementia?

Studies on antipsychotics and dementia indicate there may be serious risks for patients prescribed antipsychotic medications to treat symptoms of dementia. Patients can have an elevated risk of stroke and death, and the mechanisms of this connection are not completely understood. This applies both to older conventional antipsychotics and the next generation of these drugs, the atypical antipsychotics. Concerns about the risks for dementia patients has resulted in serious warnings from regulatory agencies like the Food and Drug Administration (FDA) in the United States as well as Britain’s National Health Service.

Patients with dementia tend to be older adults, who may experience dementia in connection with a variety of cognitive conditions. Some of the symptoms can include hallucinations, paranoia, and agitation, the same symptoms that can be effectively managed with antipsychotics in patients with mental illness. This led some medical providers to start recommending antipsychotics for older adults with dementia. As their use increased, researchers started to notice a troubling connection between antipsychotics and dementia.

They noted that patients had a higher risk of stroke if they took these medications for an extended period of time. Their overall risk of death was also elevated, indicating an adverse connection between antipsychotics and dementia. After controlling for other factors, the medications were the only consistent connection. Some researchers suggested limiting the use of the medications and including a warning label on drugs to alert patients to the concerns shared by members of the medical community.

Many antipsychotic medications are not approved for use in dementia treatment, with the exception of risperidone, because specific clinical trials on antipsychotics and dementia haven't determined whether they are safe for use, and what the dosage recommendations should be. Risperidone is generally only recommended for short term use, as it can cause adverse effects when used for longer than six weeks. In individual cases, antipsychotics may be appropriate and effective in the treatment of dementia symptoms, but it is important to evaluate the patient individually and to stay alert to warning signs. While using these medications can increase independence and functionality, it can also create risks for the patient.

Doctors considering antipsychotics and dementia may discuss the situation with patients and their family members. They can talk about the risks and benefits, as well as signs to watch out for, and the possibility of using temporary drug therapy to stabilize a patient and then reassessing. Issues like slurred speech, increased confusion, and other indicators of cognitive decline that are abnormal for the patient should be reported to a medical professional.