Abstract
Objective
To assess all-cause mortality patients with dementia treated with typical and atypical
antipsychotic drugs (APDs).
Design
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.
Measurements
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.
Results
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.
Conclusions/Implications
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.
Keywords
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Article info
Footnotes
SveDem is supported financially by the Swedish Brain Power network (http://swedishbrainpower.se), the Swedish Associations of Local Authorities and Regions, Gun och Bertil Stohnes Stiftelse, CIMED grant, Alzheimerfonden, and Swedish Research Council (Drn 2012-2291 and Drn 2016-02317), and by grants provided by the Stockholm County Council (ALF project). None of the sponsors had any involvement in the design of the study, the data collection and analysis, the writing of the report, or the decision to submit the paper for publication.
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
This study was approved by the regional ethical review board in Stockholm, Sweden. Ethical Number: 2015/2232-31/5.
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
