Risk for Adverse Outcomes Increased With Antipsychotic Use in Dementia

Risks increased for stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, acute kidney injury

By Elana Gotkine HealthDay Reporter

FRIDAY, April 19, 2024 (HealthDay News) — For adults with dementia, antipsychotic use is associated with increased risks for stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, according to a study published online April 17 in The BMJ.

Pearl L.H. Mok, Ph.D., from the University of Manchester in the United Kingdom, and colleagues conducted a population-based matched cohort study to examine the risks for adverse outcomes associated with antipsychotic use in adults with dementia (aged 50 years and older) diagnosed between Jan. 1, 1998, and May 31, 2018. Using incidence density sampling, each of 35,339 new antipsychotic users was matched to up to 15 nonusers.

The researchers found that antipsychotic use was associated with increased risks for all outcomes compared with nonuse, except for ventricular arrhythmia. There were associations for current use (90 days after a prescription) with elevated risks for pneumonia, acute kidney injury, venous thromboembolism, stroke, fracture, myocardial infarction, and heart failure (hazard ratios, 2.19, 1.72, 1.62, 1.61, 1.43, 1.28, and 1.27, respectively). There was no increased risk for the negative control outcomes of appendicitis or cholecystitis. The cumulative incidence of pneumonia was 4.48 and 1.49 percent among antipsychotic users and nonusers, respectively, in the 90 days after drug initiation.

“Our finding that antipsychotics are associated with a wider range of risks than previously known is therefore of direct relevance to guideline developers, regulators, and clinicians considering the appropriateness of antipsychotic prescribing for behavioral and psychological symptoms of dementia,” the authors write.