Antipsychotics and Alzheimer's Disease
Recently, the American Journal of Psychiatry published a study about the use of antipsychotic medications in people suffering with Alzheimer's disease. The use of these drugs in this illness has been hotly debated in the past few years. In 2005 the FDA issued a black box warning that the newer, atypical antipsychotic medications could increase the risk of pneumonia and heart attacks in elderly people with dementia. In 2007 another black box warning was issued, this time for the older, typical antipsychotic medications. This warning noted an increased risk of death in the elderly people with dementia. This new article, written by Dr. Sultzer and colleagues, is based on data from The Clinical Antipsychotic Trials of Intervention Effectiveness- Alzheimer's Disease (CATIE-AD). The study included 421 people with Alzheimer's disease agitated behavior or psychosis who were given an antipsychotic medication or placebo, and monitored for up to 36 weeks. The results suggests that certain symptoms, including anger, paranoid ideas, and aggression, may be improved with certain antipsychotic medications. Unfortunately, the study also suggests that despite improvement in certain symptoms, the use of antipsychotic medications doesn't improve measures of quality of life, need for care, or functioning overall.
Alzheimer's disease can be a devastating illness, and it can be very troubling if on top of the confusion and memory problems, the person also becomes paranoid and doesn't trust people who are trying to help them. This paranoia can be as intense as paranoia experience by someone with schizophrenia. I have had patients who told me they worried that government agents were attempting to infiltrate their homes, that upstairs neighbors were pouring poisonous gas through the vents, or that the anchor on the news was specifically talking about them and their lives in very sinister terms. The paranoia and agitation some patients with Alzheimer's disease can be worse than the memory problems that define it.
Family members are sometimes worried that their loved ones with Alzheimer's disease may be overmedicated. This article presents some long awaited results, and shows that antipsychotic medications may have some real benefit in treating certain symptoms. Since the black box warnings of 2005 and 2007, there has been a lot of discussion of antipsychotic medication use to treat symptoms of paranoia and aggression in people who have dementia. This situation is not made any easier by the fact that there are really no other medications proven to work any better or be any safer. The CATIE trials for schizophrenia and Alzheimer's disease are two of the largest studies of their kind, and the findings from these studies will no doubt be discussed at academic centers all over the world. I welcome your questions and comments on the relevance of this study and I am especially interested in hearing your questions or concerns about the use of antipsychotic medications.