Antipsychotic Use in Dementia: A Systematic Review of Benefits and Risks From Meta-Analyses

Tampi, Rajesh R.; Tampi, Deena J.; Balachandran, Silpa; Srinivasan, Shilpa

doi:10.1016/j.jagp.2017.01.087

Cited by 50 publications

(79 citation statements)

References 46 publications

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“…Possible reasons for the decreased prevalence of antipsychotic use among antidementia drug users in more recent studies are the accumulated evidence of the adverse effects of antipsychotic use in people with dementia and the corresponding safety warnings issued by the Japanese regulatory authority in 2009. Another possible reason is the increased use of memantine since its introduction in 2011.…”

Section: Discussionmentioning

confidence: 99%

“…One of the major challenges of caring for people with dementia is managing the behavioral and psychological symptoms of dementia (BPSD) . Antipsychotics have been used for BPSD management, despite off‐label use . Indeed, antipsychotics are associated with greater risks for mortality and cerebrovascular events, which has led regulatory agencies to issue warnings or required pharmaceutical companies to add precautions about the use of antipsychotics for people with dementia .…”

Section: Introductionmentioning

confidence: 99%

“…Antipsychotics have been used for BPSD management, despite off‐label use . Indeed, antipsychotics are associated with greater risks for mortality and cerebrovascular events, which has led regulatory agencies to issue warnings or required pharmaceutical companies to add precautions about the use of antipsychotics for people with dementia . However, antipsychotics have still been commonly prescribed in older adults with dementia in Japan and in overseas countries, even after the issue of such warnings or precautions.…”

Section: Introductionmentioning

confidence: 99%

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Antipsychotic use and related factors among people with dementia aged 75 years or older in Japan: A comprehensive population‐based estimation using medical and long‐term care data

Kuroda

Hamada

Sakata

et al. 2018

Int J Geriat Psychiatry

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Objectives Antipsychotics are used to manage the behavioral and psychological symptoms of dementia (BPSD), despite their association with greater risks for mortality and cerebrovascular events. Previous studies in Japan have estimated the prevalence of antipsychotics among older adults who took antidementia drugs. Using long‐term care (LTC) data, we aimed to obtain more accurate estimates of the prevalence of antipsychotics and to determine factors related to their use in older adults with dementia. Methods Medical and LTC claims data and LTC certification data between April 2012 and September 2013 were obtained from a middle‐sized suburban city. The 1‐year prevalence of antipsychotic use was estimated among individuals with probable dementia aged greater than or equal to 75 years who were prescribed antidementia drugs and/or had dementia based on LTC needs certification data. Results Of 25 919 participants, 4865 had probable dementia and 1506 were prescribed antidementia drugs. The prevalence of antipsychotics among participants with probable dementia was 10.7%, which was lower than that in those who were prescribed antidementia drugs (16.4%). Among participants with probable dementia with LTC certification data available (N = 4419), lower cognitive function (vs mild; adjusted odds ratio 2.16, 95% confidence interval 1.63‐2.86), antidementia drug use (2.27, 1.84‐2.81), and institutional LTC services use (2.34, 1.85‐2.97) were associated with greater odds of antipsychotic use, whereas older age (greater than or equal to 92 years) was associated with lower odds (vs less than 77 years; 0.42, 0.27‐0.65). Conclusions These findings may be useful for estimating the burden of BPSD and for taking measures to reduce inappropriate antipsychotic prescription.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antipsychotic use and related factors among people with dementia aged 75 years or older in Japan: A comprehensive population‐based estimation using medical and long‐term care data

Kuroda

Hamada

Sakata

et al. 2018

Int J Geriat Psychiatry

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“…The most troublesome psychiatric events such as aggression and the remaining symptoms psychosis and agitation are addressed with atypical antipsychotics administered off-label [6]. However, the clinical efficacy of these drugs is unsatisfactory because a large percentage of patients do not respond or respond partially to the drugs [7]. Moreover, atypical antipsychotics are not actually recommended for elderly patients because they pose a risk of many side effects [8].…”

Section: Introductionmentioning

confidence: 99%

Management of Dementia-Related Psychosis, Agitation and Aggression: A Review of the Pharmacology and Clinical Effects of Potential Drug Candidates

et al. 2020

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Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms of dementia, such as psychosis, aggression, agitation, and depression. Atypical antipsychotics are commonly prescribed off-label to manage certain symptoms, despite warnings from the regulatory agencies regarding the increased risk of mortality associated with their use in elderly patients. Moreover, these compounds display a limited clinical efficacy, mostly owing to the fact that they were developed to treat schizophrenia, a disease characterized by neurobiological deficits. Thus, to improve clinical efficacy, it has been suggested that patients with dementia should be treated with exclusively designed and developed drugs that interact with pharmacologically relevant targets. Within this context, numerous studies have suggested druggable targets that might achieve therapeutically acceptable pharmacological profiles. Based on this, several different drug candidates have been proposed that are being investigated in clinical trials for behavioral and psychological symptoms of dementia. We highlight the recent advances toward the development of therapeutic agents for dementia-related psychosis and agitation/ aggression and discuss the relationship between the relevant biological targets and their etiology. In addition, we review the compounds that are in the early stage of development (discovery or preclinical phase) and those that are currently being investigated in clinical trials for dementia-related psychosis and agitation/aggression. We also discuss the mechanism of action of these compounds and their pharmacological utility in patients with dementia.

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“…Psychotropic medicines (antipsychotics, benzodiazepines and antidepressants) are commonly prescribed for the management of BPSD in PwD despite their limited e cacy and severe adverse effects [9,10], and currently, there is a high prevalence of dispensing of these medicines [11]. Surprisingly, only 10% of psychotropic medications prescribed to treat BPSD in PwD has been estimated to be appropriate [12], but these medications are often overprescribed than what has been recommended to be optimal [13].…”

Section: Backgroundsmentioning

confidence: 99%

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

Parajuli

Kuot

Hamiduzzaman

et al. 2020

Preprint

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BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold (PLST) and person-centered music intervention.MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n = 31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers before the intervention and after 6 months. Fifty-three staff participated in 31 semi-structured interviews and 8 focus group at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% in the use of at least any psychotropic medication, 19.6% reduction in antipsychotics and benzodiazepines, and 6.5% reduction in antidementia medicines prescription from baseline to at post-intervention, however, these were not statistically significant. There was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use, introducing a rest period and the music intervention combined was an alternative approach for medications use, and less behaviors, and ultimately the less use of medications.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

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Antipsychotic Use in Dementia: A Systematic Review of Benefits and Risks From Meta-Analyses

Cited by 50 publications

References 46 publications

Antipsychotic use and related factors among people with dementia aged 75 years or older in Japan: A comprehensive population‐based estimation using medical and long‐term care data

Antipsychotic use and related factors among people with dementia aged 75 years or older in Japan: A comprehensive population‐based estimation using medical and long‐term care data

Management of Dementia-Related Psychosis, Agitation and Aggression: A Review of the Pharmacology and Clinical Effects of Potential Drug Candidates

Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

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