Original Study| Volume 20, ISSUE 3, P323-329.e2, March 2019

Antipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study

  • Emilia Schwertner
    Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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  • Juraj Secnik
    Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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  • Sara Garcia-Ptacek
    Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

    Department of Internal Medicine, Section for Neurology, Södersjukhuset, Stockholm, Sweden
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  • Björn Johansson
    Department of Molecular Medicine and Surgery Stockholm, Karolinska Institutet, Sweden

    Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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  • Katarina Nagga
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden

    Department of Acute Internal Medicine and Geriatrics, Linköping University, Linköping, Sweden
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  • Maria Eriksdotter
    Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

    Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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  • Bengt Winblad
    Theme Aging, Karolinska University Hospital, Huddinge, Sweden

    Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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  • Dorota Religa
    Address correspondence to Dorota Religa, PhD, Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Clinical geriatrics, Sektionen För Klinisk Geriatrik, Plan 7 141 83 Huddinge, Sweden.
    Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden

    Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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      To assess all-cause mortality patients with dementia treated with typical and atypical antipsychotic drugs (APDs).


      Registry-based cohort study.

      Setting and participants

      A total of 58,412 patients diagnosed with dementia and registered in the Swedish Dementia Registry were included in the study. Of the study sample, 2526 of the patients were prescribed APDs. Of these, 602 patients were prescribed typical APDs and 1833 patients were prescribed atypical APDs. Ninety-one patients were prescribed both typical and atypical APDs.


      All-cause mortality based on Swedish Cause of Death Register. Adjusted hazard ratios of mortality were calculated according to class of APDs (typical or atypical) prescribed. Final models were adjusted for age at dementia diagnosis, sex, Charlson comorbidity index, living arrangement, and Mini-Mental State Examination.


      In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3–1.5). After stratifying for dementia types, increased mortality risks associated with APDs were found in patients with Alzheimer's disease, mixed dementia, unspecified dementia, and vascular dementia. Higher risk for mortality was found with typical APDs in patients with mixed and vascular dementia and with atypical APDs in patients with Alzheimer's disease, mixed, unspecified, and vascular dementia. Furthermore, in patients with Alzheimer's disease who had typical APDs, use lower risk of death emerged in comparison with patients with atypical APDs.


      Both the use of atypical and typical APDs increased the risk of death in patients with dementia even after adjusting for differences in basic characteristics between groups. Although we cannot rule out the influence of residual confounding, these results would seem to add to studies suggesting caution in APD prescription for patients with dementia.


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