Dementia patient twice as likely to die from drugs, researchers warn

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By Jenny Hope

Last updated at 9:44 AM on 24th February 2012

Elderly people in nursing homes with dementia run double the risk of dying from certain ‘chemical cosh’ drugs, warn researchers.

Alarm bells have been sounded about the dangers of premature death caused by antipsychotic drugs in recent years, but a new study shows some are more risky than others.

It found people over 65 taking haloperidol had double the risk of death compared with those taking a newer drug called risperidone.

A study has found that people over 65 taking haloperidol, pictured, had double the risk of death compared with those taking a newer drug called risperidone

Those taking highest doses of antipsychotic drugs - often known as the ‘chemical cosh’ because they are wrongly used to sedate elderly patients - were at greatest risk.

The Harvard Medical School study, the largest ever undertaken among US nursing home residents, looked at 75,445 older nursing home residents between 2001 and 2005.

The drugs investigated in the study are all used in nursing homes and on general hospital wards in the UK.

 

A Government-commissioned review in 2009 found 180,000 people with dementia were prescribed antipsychotics, of which 144,000 were given them inappropriately.

Research suggests this could mean 23,500 people dying prematurely each year.

Haloperidol, which was originally licensed for schizophrenia and other psychiatric conditions, is one of the oldest used, while newer antipsychotics include risperidone and quetiapine.

A Government-commissioned review in 2009 found 180,000 people with dementia were prescribed antipsychotics, of which 144,000 were given them inappropriately

In the six-month study published in bmj.com - the online edition of the British Medical Journal - researchers found 6,598 nursing home residents died, almost nine per cent.

Patients treated with haloperidol had double the risk of death compared with those taking risperidone, the most commonly prescribed drug which was used for comparison with the other five drugs.

The effect of haloperidol was strongest in the first 40 days of treatment, while those taking quetiapine (sold under the brand Seroquel) had a slightly reduced risk of death.

There was no significant effect on death rates from the other drugs, aripiprazole, olanzapine (marketed as Zyprexa) and ziprasidone.

Almost half of deaths were recorded as due to circulatory disorders, 10 per cent due to brain disorders and 15 per cent to respiratory disorders.

The experts concluded ‘The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine.’

The Daily Mail has long called for an improvement in the care of dementia sufferers as part of our Dignity for the Elderly Campaign.

Manchester University academics earlier this week found more than a quarter of elderly patients with dementia were receiving antipsychotics, sometimes for years even though they are supposed to be used for a few weeks at most.

Most antipsychotic drugs are not licensed for treatment of dementia but are frequently prescribed to control agitation and aggressive behaviour, making life easier for carers and nursing home staff.

But Dr Anne Corbett, research manager at the Alzheimer’s Society charity, said the practice must stop.

She said ‘This research supports existing studies that have shown antipsychotics can raise the risk of death, particularly when used over the longer term.

‘As many as 150,000 of the 180,000 people with dementia who are on the drugs in the UK have been prescribed inappropriately. For a minority of people with dementia antipsychotics should be used, but then only for up to twelve weeks, and under the correct circumstances.

‘People with dementia are currently having their lives put at risk because of dangerous antipsychotic medication. Too often we hear about an over-reliance on medication as a response to distressed reactions of people with dementia, when a person-centred approach is what is required.

‘This needs to stop now. There has been some progress but good care rather than antipsychotics must become the norm. Staff need to be trained and supported to be empowered to provide person-centred care.’

 

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Dementia patient twice as likely to die from drugs, researchers warn

Risk found with drugs used for dementia

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The Irish Times - Friday, February 24, 2012

DR MUIRIS HOUSTON

DRUGS USED to treat symptoms of dementia in older people in nursing homes have been linked to an increased risk of death, research published today suggests.

The largest study of nursing home residents in the US, carried out by researchers from Harvard University Medical School, has established the risk associated with individual anti-psychotic drugs. Some 75,500 nursing home residents over the age of 65 were studied over six months.

Almost half of deaths in those taking anti-psychotic medication were due to circulatory disorders, such as stroke and heart attack. Some 10 per cent of deaths were due to brain disorders, while 15 per cent were attributed to respiratory disorders.

After adjusting for age, sex and other physical illnesses that could raise the risk of mortality, the researchers report in the British Medical Journal that patients treated with the drug haloperidol had double the risk of death compared with those taking a more modern drug called risperidone.

The prescription of this class of drugs has diminished following warnings from drug regulatory authorities in recent years about its overuse.

A 2006 study carried out in the west of Ireland found that more than one in 10 residents of nursing homes and long-stay units for the elderly were receiving inappropriate medication to deal with the symptoms of dementia.

Anti-psychotic drugs, also known as major tranquillisers, are primarily used to treat schizophrenia, severe depression, bipolar disorder and other causes of psychotic behaviour. Using the drugs to treat restlessness, wandering and the intermittent aggression found in some patients with dementia is considered inappropriate.

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Risk found with drugs used for dementia

Preventing Dementia: Facts and Fiction – Video

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07-07-2011 15:05 What can be done to prevent diseases of the aging brain? Doctors Adam Gazzaley, Brianne Bettcher and Ron Finley discuss the latest studies exploring efforts to forestall the effects of dementia in older adults. The potential benefits of cognitive training, exercise, drugs and dietary supplements are all covered in an attempt to distinguish what really works versus the hype. Series: "UCSF Mini Medical School for the Public" [7/2011] [Health and Medicine] [Show ID: 21374]

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Preventing Dementia: Facts and Fiction - Video

Certain Antipsychotics Up Risk of Death for Patients With Dementia: Study

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THURSDAY, Feb. 23 (HealthDay News) Compared to other antipsychotic drugs, haloperidol (Haldol) raises the risk of death in elderly patients with dementia, a new study finds.

One outside expert believes the finding should aid in dementia care. "This data provides much-needed guidance and reassurance for the ever-increasing number of health care practitioners treating older demented patients," said Dr. Gisele Wolf-Klein, director of geriatric education at the North Shore-LIJ Health System in New Hyde Park, N.Y.

The study was published online Feb. 23 in the British Medical Journal.

In 2005, the U.S. Food and Drug Administration warned that certain antipsychotic drugs are associated with an increased risk of death in elderly patients with dementia. This warning was expanded to include conventional antipsychotics in 2008, according to a journal news release.

The authors of the new study said that, despite the FDA action, the use of antipsychotic drugs for this patient population is likely to grow. According to the Harvard Medical School researchers, that's because there are a growing number of elderly patients with dementia who require some type of treatment.

Wolf-Klein agreed, noting that safety concerns over the use of antipsychotics are "leaving primary care physicians, geriatricians, neurologist and psychiatrists in a quandary as they attempt to respond to overwhelmed caregivers dealing with unmanageable behaviors at home. Discussion with family members of the risks and benefits of atypical antipsychotics creates additional stress and burden in an already difficult situation."

In the study, the Harvard group examined 2001-2005 data from more than 75,000 nursing home residents, aged 65 and older, in facilities across 45 states. They sought to assess the risk of death associated with widely used antipsychotic drugs such as aripiprazole, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone.

During the six-month study period, about 6,600 of the nursing home residents died from causes that were unrelated to cancer. Those who took haloperidol had double the risk of death compared to those who took risperidone, while those who took quetiapine (Seroquel) had a lower risk of death.

The researchers found that the effect of haloperidol was strongest during the first 40 days of treatment and that this did not change after doses were adjusted. Circulatory disorders accounted for 49 percent the deaths, respiratory disorders for 15 percent and brain disorders for 10 percent.

Not all antipsychotic medications carry the same risk of death in elderly patients and doctors "may want to consider this evidence when evaluating ... the best approach to treatment of behavioral problems," the researchers wrote.

Wolf-Klein said the study offers doctors valuable guidance going forward, and she called it "a landmark approach to addressing the pressing clinical need of practicing physicians confronted with behavioral issues in elderly demented patients."

More information

The American Academy of Family Physicians has more about dementia.

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Certain Antipsychotics Up Risk of Death for Patients With Dementia: Study

Midlife and Late-Life Depressive Symptoms Associated with Dementia

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ScienceDaily (May 7, 2012) Depressive symptoms that are present in midlife or in late life are associated with an increased risk of developing dementia, according to a report in the May issue of Archives of General Psychiatry, a JAMA Network publication.

Nearly 5.3 million individuals in the United States have Alzheimer disease (AD) and the resulting health care costs in 2010 were roughly $172 billion, the authors write as background information in the study. "Prevalence and costs of AD and other dementias are projected to rise dramatically during the next 40 years unless a prevention or a cure can be found. Therefore, it is critical to gain a greater understanding of the key risk factors and etiologic underpinnings of dementia from a population-based perspective," the authors write.

Deborah E. Barnes, Ph.D., M.P.H., of the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center, and colleagues evaluated data from 13,535 long-term Kaiser Permanente members and examined depressive symptoms assessed in midlife (1964-1973) and in late life (1994-2000) and risks of developing dementia, Alzheimer disease (AD) and vascular dementia (VaD; dementia resulting from brain damage from impaired blood flow to the brain).

Depressive symptoms were present in 14.1 percent of study participants in midlife only, 9.2 percent in late life only and 4.2 percent in both. During six years of follow-up, 22.5 percent of patients were diagnosed with dementia; 5.5 percent with Alzheimer disease and 2.3 percent with VaD.

When examining AD and VaD separately, patients with late-life depressive symptoms had a two-fold increase in AD risk, and patients with midlife and late-life symptoms had more than a three-fold increase in VaD risk.

"Our findings suggest that chronic depression during the life course may be etiologically associated with an increased risk of dementia, particularly VaD, whereas depression that occurs for the first time in late life is likely to reflect a prodromal stage of dementia, in particular AD," the authors conclude.

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The above story is reprinted from materials provided by American Medical Association (AMA), via Newswise.

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Midlife and Late-Life Depressive Symptoms Associated with Dementia

Lifelong depression may increase risk of vascular dementia

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Public release date: 7-May-2012 [ | E-mail | Share ]

Contact: Vincent Staupe vstaupe@golinharris.com 415-318-4386 Kaiser Permanente

OAKLAND, Calif., May 7, 2012 Depressive symptoms that occur in both midlife and late life are associated with an increased risk of developing vascular dementia, while symptoms that occur in late life only are more likely to be early signs of Alzheimer's disease, according to University of California at San Francisco and Kaiser Permanente researchers.

The study, which appears in the current issue of the Archives of General Psychiatry, is the first to examine whether midlife or late-life depression is more likely to lead to either Alzheimer's disease or vascular dementia in the long term. The researchers explain that vascular dementia, the second most common type of dementia, develops when impaired blood flow to parts of the brain deprives cells of nutrients and oxygen.

"People who had depressive symptoms in both midlife and late life were much more likely to develop vascular dementia, while those who had depressive symptoms in late life only were more likely to develop Alzheimer's disease," said the study's lead author Deborah E. Barnes, PhD, MPH, with the UCSF Departments of Psychiatry and Epidemiology & Biostatistics and the San Francisco Veterans Affairs Medical Center.

"The findings have important public health implications because they raise hope that adequate treatment of depression in midlife may reduce dementia risk, particularly vascular dementia, later in life," added Rachel Whitmer, PhD, a research scientist at the Kaiser Permanente Northern California Division of Research and the principal investigator of the study.

UCSF and Kaiser Permanente investigators examined the association between depressive symptoms and dementia over the course of 45 years in a longitudinal study of more than 13,000 long-term members of the Kaiser Permanente Northern California integrated care delivery system. The study population consisted of members who participated in a voluntary health examination called the Multiphasic Health Checkup in San Francisco and Oakland during 1964-1973 when they were 40-55 years old.

Participants were evaluated for depressive symptoms in midlife as part of the Multiphasic Health Checkup and again in late life between 1994-2000. Between 2003-2009, 3,129 participants were diagnosed with dementia.

Though more research is needed, the findings suggest that depression that begins in late life may be an early symptom of Alzheimer's disease, while chronic depression over the life course may reflect a long-term process of changes to blood flow in the brain associated with increased risk of vascular dementia.

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Lifelong depression may increase risk of vascular dementia

Cognitive condition is not dementia

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Dear Dr. Donohue Will you please discuss mild cognitive impairment? A family member, 78, is forgetful. He took a battery of tests and was diagnosed as having MCI. Which medical specialist cares for MCI patients? Should other tests be done to be sure of the diagnosis? Are there vitamins one should take? Activities? Which medicine works best? Where do we go for support? Can a patient have MCI for years without developing dementia? J.C.

Answer Mild cognitive impairment is many steps below dementia illnesses such as Alzheimer's, and a few steps above the memory problems that happen to just about everyone your relative's age. People with MCI function quite well. They carry on daily activities without great impairment. They're able to reason, to have insight into what others say and to display the proper emotional reactions to life's many difficulties. Memory isn't what it used to be. MCI might make a person forget a medical or dental appointment or a phone conversation, or not remember the outcome of a sporting event in someone who is a sports aficionado.

Not every MCI patient is doomed to the dementia of Alzheimer's disease. Around 5 percent of those diagnosed with it do progress to Alzheimer's every year.

The family doctor takes care of MCI patients. If a specialist is preferred, a neurologist fits the bill. Your relative has had enough tests to make a reasonable diagnosis. More esoteric tests are limited to centers doing research in dementia. No Food and Drug Administration-approved medicine exists for MCI. Some doctors put their MCI patients on drugs used for Alzheimer's disease, such as Aricept (donepezil). Others wait until a person has obvious signs of Alzheimer's.

No vitamin works. Keep your relative as active as possible. If he has hobbies, encourage him to stay active in them.

A person can have MCI for years and years, and not develop Alzheimer's. You can contact the Alzheimer's Association at 1-800-272-3900 or online at http://www.alz.org. I didn't check with the association, but I'm sure it can provide you with information on MCI.

The booklet on Alzheimer's disease also is helpful. To obtain a copy, write: Dr. Donohue No. 903, Box 536475, Orlando, Fla. 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please wait four weeks for delivery.

Write Dr. Donohue at P.O. Box 536475, Orlando, Fla. 32853-6475.

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Cognitive condition is not dementia

Nationwide dementia screening to tackle 'crisis' among elderly

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Screening will also be introduced into the NHS health check programme for people aged 40 to 74.

Mr Lansley told the Daily Mail: When you talk to people about their concerns for the future, its evident that dementia is a bigger concern even than having cancer.

We are looking for early diagnosis where physiological signs might not be as easy to pick up.

We are increasingly able to support people with early diagnosis to sustain their memory and their overall mental agility.

Sufferers of dementia, which causes the mind to deteriorate, currently fill a quarter of all hospital beds.

Health ministers are also concerned that the 19 billion cost of treating Britains 67,000 dementia patients every year is higher than that of treating cancer, heart disease or stroke sufferers.

Alzheimer's Disease is the most common cause of dementia and the most feared complaint among people over the age of 55 in the UK, behind cancer and stroke. However, only one in four people with the illness are diagnosed.

As the NHS struggles with this cost, Mr Cameron plans to improve research on living with dementia and fund a new academic centre for scientists to investigate the causes of the condition.

He also wants to encourage people to volunteer for brain scanning to help identify the signs of early onset.

We did it with cancer in the 70s. With HIV in the 80s and 90s, he will say. We fought the stigma, stepped up to the challenge and made massive inroads into fighting these killers.

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Nationwide dementia screening to tackle 'crisis' among elderly

Funding doubled in effort to defeat dementia crisis

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Funding for dementia research will be more than doubled by 2015 to tackle "one of the greatest challenges of our time" and make Britain a world leader in the field, David Cameron will announce today.

Declaring the problem a personal priority, the Prime Minister will say there must be a collective fight against the "quiet crisis", in the same way there was against cancer and HIV. Thought to affect 670,000 people although about 400,000 have not been diagnosed and do not know they have it dementia is estimated to cost the UK 23bn a year. The number affected is expected to rise to one million in the next 10 years.

Launching a "national challenge on dementia", Mr Cameron will say funding for dementia research will reach 66m by 2015, from 26.6m 2010.

"One of the greatest challenges ... is what I'd call the quiet crisis, one that steals lives and tears at the hearts of families, but that relative to its impact is hardly acknowledged," he will say today. He will say that dementia is a terrible disease and it is a scandal that the UK has failed to keep pace with it.

"It is as though we've been in collective denial," Mr Cameron will declare. Labelling the issue a "national crisis", he will add that there needs to be an all-out fight-back against this disease that cuts across society. "We did it with cancer in the 70s. With HIV in the 80s and 90s. We fought the stigma, stepped up to the challenge and made massive in-roads into fighting these killers. Now we've got to do the same with dementia," Mr Cameron will say.

Jeremy Hughes, chief executive of the Alzheimer's Society, said that it was "an unprecedented step".

Mr Hughes said: "Doubling funding for [dementia] research, tackling diagnosis and calling for a radical shift in the way we talk, think and act on dementia will help to transform lives."

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Funding doubled in effort to defeat dementia crisis