Atypical antipsychotic drugs may hasten dementia decline

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Medscape Today
Deborah Brauser

Use of atypical antipsychotics to treat agitation or psychosis in patients with Alzheimer's disease (AD) may lead to severe cognitive impairment, according to new findings from the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer's Disease (CATIE-AD) study.

In the analysis, investigators found that patients with AD randomly assigned to olanzapine, quetiapine, or risperidone showed a significant decrement in neuropsychological functioning, as seen on several cognition measurements, compared with those receiving placebo.

"We found that the atypical antipsychotics used in this study were as a group associated with worsening cognitive function and that the magnitude of this impairment was, on average, the rough equivalent of 1 year's progression of illness," principal investigator of the CATIE-AD studies Lon S. Schneider, MD, professor of psychiatry, neurology, and gerontology at the University of California (USC) Keck School of Medicine in Los Angeles, told Medscape Medical News.

"It really comes down to the fact that the current medications aren't very effective in treating agitation, aggression, or psychosis in dementia. So maybe we should be trying to address these problems in different ways than merely prescribing the medications that have been licensed for treating patients with schizophrenia or major depression."

The study is published in the August issue of the American Journal of Psychiatry.

Efficacy Offset by Adverse Effects

"Delusions or hallucinations appear in 30% to 50% of patients with AD, and up to 70% demonstrate agitated or aggressive behaviors," report the researchers.

In a meta-analysis conducted the same year, Dr. Schneider's team found small effect sizes on symptom rating scales for aripiprazole and risperidone along with significant adverse events, including cerebrovascular events and worsening cognitive test scores, in older patients with AD.

"Any advantages of efficacy found for these drugs were offset in general by lack of tolerability and by adverse effects. So they should be used with a