October 4, 2023
Drugs to treat psychosis are often prescribed to ease agitation and aggression in people with Alzheimer’s disease. But the powerful medications carry potentially serious, even fatal, side effects, so doctors caution that they should be used sparingly and avoided when possible.
Despite these warnings, many people with Alzheimer’s who are living at home may be needlessly taking the drugs, or taking excessively high doses of the drugs, according to a new report. Overuse of these drugs may be putting their overall health in jeopardy.
“Antipsychotic use in persons with dementia is a serious patient safety issue,” said study author Jinjiao Wang, of the University of Rochester. If a loved one with Alzheimer’s is taking one of these drugs, Dr. Wang advised, family members should review with doctors regularly whether the drug is truly needed or whether the dose might be reduced.
For the study, Dr. Wang and colleagues reviewed the medical records of 6,684 men and women aged 65 and older who were receiving home health care in New York state. They found that those with Alzheimer’s disease or other forms of dementia were more than twice as likely to be using antipsychotic drugs than their peers of similar age who did not have dementia. Specifically, more than 17 percent of those with Alzheimer’s disease or related dementias were taking antipsychotics, compared to 6.6 percent of those who did not have dementia.
The most prescribed antipsychotic drug was quetiapine (which goes by the brand name Seroquel). Other common antipsychotics include haloperidol (Haldol), olanzapine (Zyprexa) and risperidone (Risperdal). All these drugs significantly increase the risk of stroke, sudden cardiac arrest, falls, head injuries and early death. The Food and Drug Administration has required since 2008 that all these drugs carry a black box warning on medication packages warning doctors about the potentially fatal risks.
Antipsychotics were most likely to be prescribed to those with Alzheimer’s who had the greatest difficulty in activities of daily living like getting dressed or preparing meals and those who had behavioral or psychological symptoms like agitation, delusions or aggression. The findings were published in the Journal of the American Geriatrics Society.
Previous studies have shown that these drugs are commonly prescribed to Alzheimer’s patients living in nursing homes, where shouting, hitting and other aggressive behaviors can make day-to-day care difficult. However, this study showed that they are also commonly prescribed to those with Alzheimer’s who live at home at rates higher than previously thought.
But while drugs in this class can ease psychotic symptoms over the short term, improvements tend to be modest at best, and benefits typically wane after six to 12 weeks. In addition, antipsychotic drugs are often over-prescribed to people with only mild symptoms like wandering or sleeplessness.
Experts say that agitation and other symptoms for which antipsychotic drugs are prescribed may be caused by an underlying condition such as pain. Finding and treating any underlying conditions is therefore important.
Other research has found that massage, touch therapy, exercise, music therapy and other non-drug treatments can be effective ways to reduce aggression and agitation in people with Alzheimer’s disease. In many cases, they should be given priority as a first course in treating disruptive behaviors in people with dementia, before drugs are tried.
Even simple environmental changes like increasing the lighting to eliminate dark and scary shadows or using contrasting colors of foods and dinnerware can make life easier and help ease agitation for people with Alzheimer’s. Approaching problems from the patient’s point of view, and not arguing or contradicting someone who cannot think clearly, can also help to ease agitation.
Sometimes antipsychotic drugs are appropriate. But the use of these drugs should be restricted to the most severe symptoms, such as severe aggression, agitation or psychosis, and risks and benefits must be carefully weighed, experts say.
Other types of drugs commonly given to those with Alzheimer’s disease, including antidepressants, anxiety medicines, seizure medications and pain-relieving opioids, can have similar side effects. Adverse effects may be compounded when different drugs are used in combination.
If you are caring for a loved one with Alzheimer’s, it is therefore critical to be aware of potential side effects of prescribed drugs and to read any boxed warnings carefully. It’s also important to review the list of medications that a loved one is on regularly with your doctor, and to consider discontinuing any drugs that may no longer be needed.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Eric Schmidt, Ph.D. Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Jinjiao Wang, Jenny Y. Shen, Yeates Conwell, et al: “Antipsychotic Use Among Older Patients With Dementia Receiving Home Health Care Services: Prevalence, Predictors, and Outcomes.” Journal of the American Geriatrics Society, September 2023.