Antipsychotics Pose New Risks for People With Dementia

Prescriptions on the rise

Researchers and regulators have been concerned about the risks of antipsychotic medication in dementia patients for decades, particularly after studies found that antipsychotic drugs increase the risk of death.

Use of the drugs for people with dementia dipped after the Food and Drug Administration issued multiple “black box” warnings — its strictest safety warning — about antipsychotics because of the increased risk of stroke and death. But their use crept up during the early phase of the COVID-19 pandemic, when lockdowns disrupted daily routines and many people with dementia, including those in nursing homes, were unable to see loved ones.

Use of these drugs is especially high in nursing homes in neighborhoods with high poverty where staff levels are low, according to a study reported on April 24 in JAMA Network Open. Nursing homes in low-income areas with staffing levels that meet government guidelines for staffing showed no significant difference in the level of antipsychotic use as higher-income areas. “Addressing staffing deficiencies, particularly in nursing homes in disadvantaged neighborhoods, will be critical for reducing the overuse of antipsychotics,” study author Jasmine Travers, assistant professor at NYU Rory Meyers College of Nursing said in a news release.

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Antipsychotic medications were developed for people with schizophrenia and other serious mental illness, but doctors may prescribe them for people with dementia “who exhibit severe behavioral and psychological symptoms that could pose a risk to themselves or others” such as patients who are aggressive or violent or who experience hallucinations or delusions, says Raya Elfadel Kheirbek, M.D., chief of gerontology, geriatrics and palliative medicine at the University of Maryland School of Medicine, who cowrote an editorial accompanying the new study. 

Patients with dementia sometimes “become paranoid, which is a way of filling in for missing information,” Gary Small, M.D., chair of psychiatry at Hackensack University Medical Center, wrote in an email. “If the patient is constantly forgetting where they put things, they may start believing that others are stealing their things.”