What should I do as a physician rounding on one of my many patients on my nursing home service with dementia, complicated by the fact that they are also are suffering from some of its effects on mood? While institutionalized skilled care remains the standard for these patients who are not able to care for themselves, the agitation and delusional thinking suffered by many patients with dementia syndromes puts a new wrinkle on the next level of care — other drugs which carry a certain risk of mortality.

Anti-psychotic drugs commonly used to treat Alzheimer’s disease may double a patient’s chance of dying within a few years, suggests a new study that adds to concerns already known about such medications. [...] Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer’s disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos. Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia

In this country, the risk associated with both the newer and older agents essentially requires physicians to frankly discuss risks and benefits with the patient’s family, principal decision makers, and other stakeholders in their care prior to using. For some, the use of these medications (which primarily are used in the mentally ill) represent the only option in dementia with extreme mood and behavioral instability. For others, options are myriad and should be sought. | LINK

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