Associated mortality risk of atypical antipsychotic medication in individuals with dementia

Peter Phiri; Tomas Engelthaler; Hannah Carr; Gayathri Delanerolle; Clive Holmes; Shanaya Rathod

doi:10.5498/wjp.v12.i2.298

Associated mortality risk of atypical antipsychotic medication in individuals with dementia

World J Psychiatry. 2022 Feb 19;12(2):298-307. doi: 10.5498/wjp.v12.i2.298.

Authors

Peter Phiri¹, Tomas Engelthaler², Hannah Carr¹, Gayathri Delanerolle³, Clive Holmes⁴, Shanaya Rathod¹

Affiliations

¹ Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom.
² Oxford Centre for Innovation, Akrivia Health, Oxford OX1 BY, United Kingdom.
³ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom.
⁴ Clinical and Experimental Sciences, University of Southampton, Southampton SO16 5ST, United Kingdom.

Abstract

Background: Antipsychotic medications such as risperidone, olanzapine and aripiprazole are used to treat psychological and behavioural symptoms among dementia patients. Current evidence indicate prescription rates for antipsychotics vary and wider consensus to evaluate clinical epidemiological outcomes is limited.

Aim: To investigate the potential impact of atypical antipsychotics on the mortality of patients with dementia.

Methods: A retrospective clinical cohort study was developed to review United Kingdom Clinical Record Interactive Search system based data between January 1, 2013 to December 31, 2017. A descriptive statistical method was used to analyse the data. Mini Mental State Examination (MMSE) scores were used to assess the severity and stage of disease progression. A cox proportional hazards model was developed to evaluate the relationship between survival following diagnosis and other variables.

Results: A total of 1692 patients were identified using natural language processing of which, 587 were prescribed olanzapine, quetiapine or risperidone (common group) whilst 893 (control group) were not prescribed any antipsychotics. Patients prescribed olanzapine showed an increased risk of death [hazard ratio (HR) = 1.32; 95% confidence interval (CI): 1.08-1.60; P < 0.01], as did those with risperidone (HR = 1.35; 95%CI: 1.18-1.54; P < 0.001). Patients prescribed quetiapine showed no significant association (HR = 1.09; 95%CI: 0.90-1.34; P = 0.38). Factors associated with a lower risk of death were: High MMSE score at diagnosis (HR = 0.72; 95%CI: 0.62-0.83; P < 0.001), identifying as female (HR = 0.73; 95%CI: 0.64-0.82; P < 0.001), and being of a White-British ethnic group (HR = 0.82; 95%CI: 0.72-0.94; P < 0.01).

Conclusion: A significant mortality risk was identified among those prescribed olanzapine and risperidone which contradicts previous findings although the study designs used were different. Comprehensive research should be conducted to better assess clinical epidemiological outcomes associated with diagnosis and therapies to improve clinical management of these patients.

Keywords: Alzheimer’s disease; Antipsychotics; Dementia; Frontotemporal dementia; Lewy bodies; Mortality; Parkinson’s and mixed; Vascular.