A systematic review of metabolic side effects related to the use of antipsychotic drugs in dementia

Abstract

A possible association between antipsychotic drugs use and weight gain might exist, in particular in subjects with mild to moderate dementia whereas no significant effects are demonstrated regarding glucose homeostasis and lipid metabolism. The antipsychotic drugs potential for causing metabolic abnormalities in older patients requires further specifically designed studies. Clinicians must be aware of this possibility even if the shorter periods of treatment administered in late-life might not be as harmful as it is in younger individuals.

Cardiovascular and metabolic comorbidities in patients with Alzheimer's disease and vascular dementia compared to a psychiatric control cohort

“…These tests are especially crucial when treatment with psychotropic drugs such as antipsychotics or antidepressants is initiated . In addition, pharmaceutical treatment can be restricted and complicated by the presence of cardiovascular and metabolic disorders with respect to applicable doses, contraindications for certain substances, drug–drug interactions, and cardiac and metabolic side‐effects …”

“…29 In addition, pharmaceutical treatment can be restricted and complicated by the presence of cardiovascular and metabolic disorders with respect to applicable doses, contraindications for certain substances, drug-drug interactions, and cardiac and metabolic side-effects. 30 Moreover, it can be assumed that in patients with cardiovascular and metabolic diseases, some pharmaceutical treatments are discontinued by outpatient general practitioners and specialists because of an increased risk of complications. 31 Consequently, psychiatric symptoms could return, leading to hospital readmission.…”

Mechanisms in endocrinology: Antipsychotic medication and type 2 diabetes and impaired glucose regulation

“…The metabolic adverse effects of antipsychotics, including dysglycaemia and weight gain, in this older population are less studied but appear to be less marked. A recent systematic review in this population included 16 drug-placebo RCTs and only four reported significant weight gain (35). Hypotheses for this include an earlier peak in the risk of developing T2DM and weight loss that is commonly seen in advanced dementia, particularly in nursing home populations.…”

Neuropsychiatric Symptoms in Dementia: Considerations for Pharmacotherapy in the USA

“…Atypical antipsychotic medications are considered one of the most robustly studied classes in the management of NPS in patients with dementia [ 37 ]. These medications have been associated with several adverse effects, such as metabolic syndrome (which includes hyperlipidemia, weight gain, hyperglycemia, and increased diabetic risk), akathisia, drug-induced parkinsonism, and tardive dyskinesia/dystonia [ 38 , 39 ]. In patients who have been treated with antipsychotic medications for several months or years, increases in the risk of death, pneumonia, cardiovascular events, parkinsonism, cognitive disturbance, gait problems including falls, and sedation have been observed [ 40 , 41 ].…”