The use of antipsychotics in institutionalized elderly patients with dementia

Abstract

Dementia is a common disease of the elderly and a frequent cause of institutionalization. Apart from relentless cognitive decline, this neurodegenerative disorder is also associated with multiple behavioural and psychiatric disturbances, which often are a source of even greater patient and caregiver distress than the cognitive decline itself. Antipsychotics are commonly used to treat these symptoms. Apart from the well known adverse effects associated with their use, recent evidence suggests additional risks, namely an increased risk of cerebrovascular accidents (CVAs) and an increased mortality, specifically when used in elderly patients with dementia. The atypical antipsychotics, particularly risperidone and olanzapine, appear to convey an even greater risk compared to the conventional agents. However, a review of the available literature, suggests that using conventional agents may be just as dangerous. A small exploratory study was carried out at St. Vincent de Paul Residence (SVPR) aiming to examine prescribing patterns of antipsychotics in institutionalized elderly patients with dementia. The study also aimed at exploring any associations between antipsychotic use and the age and sex of the patients, as well as level of cognitive impairment as measured with the mini-mental state examination (MMSE) and duration of institutionalization. Details of any antipsychotic dosing regimens were obtained and the use of other psychotropic drugs was assessed simultaneously. A random sample of 25 men and 25 women with dementia was chosen. A detailed proforma with all the above variables was filled in for each patient and the data subsequently analysed. The small sample size excluded any attempts at formal statistical analysis, which was beyond the scope of the study. [...]