Friday, January 9, 2009

Strongest drugs ‘double risk of death’ for dementia sufferers

From The TimesJanuary 9, 2009

Strongest drugs ‘double risk of death’ for dementia sufferers

David Rose
Alzheimer’s patients who are given powerful drugs to calm them down are almost twice as likely to die prematurely as those not given the medication, a study has found.

It is estimated that more than 100,000 elderly people are given antipsychotic drugs each year, despite warnings that they should not be given to people with dementia.

The latest research found that, after three years, fewer than a third of people on antipsychotics were alive compared with nearly two thirds given an inactive placebo, suggesting that up to 23,500 dementia patients are dying prematurely each year.

The sedative drugs are normally given to people with serious mental illnesses, such as schizophrenia, and are not licensed to treat Alzheimer’s.

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Campaigners say that the treatments are commonly prescribed unofficially as a “chemical cosh” to control agitation, delusions, sleep disturbance and aggression in difficult patients.

Previous research has shown that the pills can accelerate mental decline and increase the risk of having a fatal stroke or developing symptoms of Parkinson’s disease, prompting charities to call for their use to be curtailed.

In many nursing homes in Europe and North America, between 30 per cent and 60 per cent of residents with dementia are often prescribed antipsychotics for more than a year, the researchers write. The study, in the journal Lancet Neurology, is the first to look at the effect of giving the drugs to Alzheimer’s patients over long periods.

It involved 128 Alzheimer’s patients in care homes, half of whom continued to take antipsychotic medications, such as risperidone or haloperi-dol, while the other half were switched to a placebo. The researchers found that the difference in survival rates between the two groups increased with time. After two years survival was 71 per cent for the placebo group and 46 per cent for the antipsychotics group. After three years 59 per cent of the placebo group were still alive compared with 30 per cent of those being treated with antipsychotics.

Clive Ballard, who led the study at King’s College London, said that the research presented serious safety concerns. He added: “It is essential to reduce the widespread long-term prescription of these drugs by using more nondrug treatments, such as psychological therapies, and more research is urgently needed to establish more effective and safer drug treatments.”

The National Institute for Health and Clinical Excellence (NICE), the medicines watchdog, says that antipsychotic drugs should be used only in severe cases for short periods.

Evidence suggests, however, that they are commonly prescribed for Alzheimer’s patients for between one and two years in Britain. A report from the all-party parliamentary group on dementia stated last year that almost three quarters of those taking the drugs were given them inappropriately – at a cost of more than £60 million a year.

The study was funded by the Alzheimer’s Research Trust. Its chief executive, Rebecca Wood, said: “The findings are a real wake-up call.”

Phil Hope, the Care Services Minister, said: “The inappropriate administration of medication is entirely unacceptable and this will be examined in the National Dementia Strategy which is due to be published shortly.”

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