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No benefit for antipsychotics in Alzheimer's disease

By Emma Wilkinson

Antipsychotic treatment has no cognitive or neuropsychiatric benefits for patients with Alzheimer's disease and should only be used as a ‘last resort', UK researchers conclude.

Their trial of 165 patients taking neuroleptic drugs found no difference in those continuing with treatment for six or 12 months and those whose treatment was stopped. Only patients with severe neuropsychiatric problems appeared to benefit from continued drug therapy, and even then the effect was not significant.

Previous research has suggested antipsychotic use can cause a range of adverse effects and substantially increase the risk of death.

The Kings College London research team insisted the results suggested doctors should be much more cautious in their use of antipsychotics.

Study leader Professor Clive Ballard, professor of age-related diseases at KCL and director of research at the Alzheimer's Society, warned there was evidence antipsychotics could treble the risk of stroke and almost double mortality in patients with dementia.'

He said: ‘Antipsychotics are over-used in treating behavioural and psychological symptoms. They must only be a last resort, used at times of severe distress or critical need.'

Dr Brian Crichton, a GP in Solihull Birmingham, and lecturer in therapeutics at the University of Warwick said the study would help fuel the important debate on use of antipsychotics in dementia patients but was too small to draw any firm conclusions.

"It's a difficult area and with an ageing population it's an increasing area and it's a challenging issue in terms of management and of course for carers.

"I think the study demonstrates there are problems with the agents we have for managing dementia patients but I wouldn't alter my practice solely on the basis of this."

King's College London, said at least 100,000 people with dementia in care homes are currently prescribed antipsychotic drugs.

And although antipsychotic drugs may have modest beneficial treatment effects for more severe and specific behavioural symptoms in some people with dementia over short-term 6-12 week periods, longer-term benefits are minimal and must be balanced with the serious adverse effects, he said.

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