Sudeep S. Gill, MD, MSc; Susan E. Bronskill, PhD; Sharon-Lise T. Normand, PhD; Geoffrey M. Anderson, MD, PhD; Kathy Sykora, MSc; Kelvin Lam, MSc; Chaim M. Bell, MD, PhD; Philip E. Lee, MD; Hadas D. Fischer, MD; Nathan Herrmann, MD; Jerry H. Gurwitz, MD; Paula A. Rochon, MD, MPH
Grant Support: By a Canadian Institutes for Health Research operating grant (no. 53124) and a Chronic Disease New Emerging Team program grant (no. 54010). The New Emerging Team program receives joint sponsorship from the Canadian Diabetes Association, the Kidney Foundation of Canada, the Heart and Stroke Foundation of Canada and the Canadian Institutes for Health Research Institutes of Nutrition, Metabolism & Diabetes and Circulatory & Respiratory Health. Dr. Gill is supported by an Ontario Ministry of Health and Long-Term Care Career Scientist Award. Dr. Bronskill is supported by a New Investigator Award through the New Emerging Team program. Dr. Anderson is supported by a Chair in Health Management Strategies from the University of Toronto. Dr. Rochon is supported by a Canadian Institutes for Health Research Investigator Award. Dr. Lee is supported by a fellowship grant from Eli Lilly.
Potential Financial Conflicts of Interest: Consultancies: P.E. Lee (Pfizer Canada, Janssen-Ortho), N. Herrmann (Janssen, Novartis, Pfizer Inc.); Honoraria: P.E. Lee (Pfizer Inc., Janssen-Ortho, Novartis), N. Herrmann (Janssen, Eli Lilly, Novartis, AstraZeneca); Expert testimony: N. Herrmann (Janssen); Grants received: P.E. Lee (Eli Lilly), N. Herrmann (Janssen).
Requests for Single Reprints: Sudeep S. Gill, MD, MSc, St. Mary's of the Lake Hospital, 340 Union Street, Kingston, Ontario K7L 5A2, Canada.
Current Author Addresses: Dr. Gill: St. Mary's of the Lake Hospital, 340 Union Street, Kingston, Ontario K7L 5A2, Canada.
Drs. Bronskill, Anderson, Bell, Fischer, and Rochon; Ms. Sykora; and Mr. Lam: Institute for Clinical Evaluative Sciences, G Wing, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Dr. Normand: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899.
Dr. Lee: St. Paul's Hospital, 1081 Burrard Street, 9th Floor, Providence Building, Vancouver, British Columbia V6T 2B5, Canada.
Dr. Herrmann: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Dr. Gurwitz: Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605.
Author Contributions: Conception and design: S.S. Gill, S.E. Bronskill, S.-L.T. Normand, G.M. Anderson, C.M. Bell, P.E. Lee, N. Herrmann, J.H. Gurwitz, P.A. Rochon.
Analysis and interpretation of the data: S.S. Gill, S.E. Bronskill, S.-L.T. Normand, G.M. Anderson, K. Sykora, K. Lam, C.M. Bell, P.E. Lee, H.D. Fischer, N. Herrmann, J.H. Gurwitz, P.A. Rochon.
Drafting of the article: S.S. Gill, S.E. Bronskill.
Critical revision of the article for important intellectual content: S.S. Gill, S.E. Bronskill, G.M. Anderson, K. Sykora, K. Lam, C.M. Bell, P.E. Lee, H.D. Fischer, N. Herrmann, J.H. Gurwitz, P.A. Rochon.
Final approval of the article: S.S. Gill, C.M. Bell, N. Herrmann, J.H. Gurwitz, P.A. Rochon.
Statistical expertise: S.S. Gill, S.E. Bronskill, S.-L.T. Normand, K. Sykora, K. Lam.
Administrative, technical, or logistic support: K. Sykora, K. Lam, H.D. Fischer.
Gill SS, Bronskill SE, Normand ST, Anderson GM, Sykora K, Lam K, et al. Antipsychotic Drug Use and Mortality in Older Adults with Dementia. Ann Intern Med. 2007;146:775-786. doi: 10.7326/0003-4819-146-11-200706050-00006
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Published: Ann Intern Med. 2007;146(11):775-786.
Various challenging behavioral and psychological symptoms commonly develop in older adults with dementia and predispose them and their caregivers to poor outcomes (1). Nonpharmacologic strategies are recommended as first-line management for these symptoms (2), but they may be difficult to implement in clinical practice (3). For many reasons, antipsychotic medications are routinely prescribed in this setting (4, 5). Conventional antipsychotics, such as haloperidol, have been available since the 1950s. Meta-analyses of clinical trials evaluating conventional antipsychotics to treat agitation in dementia show that these agents have modest efficacy and important adverse effects compared with placebo (6, 7). In the past decade, use of newer “atypical” antipsychotics has been rapidly increasing in clinical practice because these agents were thought to produce fewer adverse effects than conventional agents (2). A Canadian study found that the prevalence of antipsychotic use in older adults increased from 2.2% in 1993 to 3.0% at the end of 2002. In that study, atypical antipsychotics, which were unavailable in 1993, accounted for 82.5% of all antipsychotics dispensed in 2002 (8). Short-term randomized, controlled trials (RCTs) have studied the role of atypical antipsychotics in the management of behavioral and psychological symptoms of dementia (2, 9). An RCT involving 421 outpatients with Alzheimer disease and psychosis, aggression, or agitation concluded that the adverse effects of these newer drugs offset their advantages (10). As a result, improvements in behavioral symptoms with antipsychotic drug treatment do not necessarily lead to improvements in overall quality of life for patients or their caregivers (11).
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Geriatric Medicine, Neurology, Dementia.
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