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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Associated mortality risk of atypical antipsychotic medication in individuals with dementia
Peter Phiri, Tomas Engelthaler, Hannah Carr, Gayathri Delanerolle, Clive Holmes, Shanaya Rathod
Peter Phiri, Hannah Carr, Shanaya Rathod, Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
Peter Phiri, Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, United Kingdom
Tomas Engelthaler, Oxford Centre for Innovation, Akrivia Health, Oxford OX1 BY, United Kingdom
Hannah Carr, Department of Psychology, University of Southampton, Southampton SO16 5ST, United Kingdom
Gayathri Delanerolle, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, United Kingdom
Clive Holmes, Clinical and Experimental Sciences, University of Southampton, Southampton SO16 5ST, United Kingdom
Clive Holmes, Research & Innovation Department, Memory Assessment & Research Centre, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
Author contributions: Phiri P and Carr H drafted the study protocol; Phiri P wrote the first draft of the manuscript version; Engelthaler T conducted the data extraction and analysis; all authors contributed to the critical revision of the manuscript and have approved the final manuscript.
Institutional review board statement: Health Research Authority (HRA) provided guidance to the Akrivia Health and all data controllers that neither ethics nor HRA approval (legal & governance) is required for the establishment of the Clinical Record Interactive Search (CRIS) system or using de-identified data (from the system) for research purposes in March 2020. Local approvals were obtained from the Southern Health NHS Foundation Trust (SHFT) patient-led oversight committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Phiri P has received other, educational from Queen Mary University of London, Stanford University School of Medicine and other from John Wiley and Blackwell, outside the submitted work. Rathod S reports other from Janssen, Otsuka and Lundbeck outside the submitted work. All other authors report no conflict of interest.
Data sharing statement: No additional data available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Peter Phiri, BSc, PhD, RN, Academic Fellow, Research & Innovation Department, Southern Health NHS Foundation Trust, Botley Road, West End, Southampton SO30 3JB, United Kingdom. peter.phiri@southernhealth.nhs.uk
Received: June 28, 2021
Peer-review started: June 28, 2021
First decision: September 5, 2021
Revised: September 24, 2021
Accepted: January 17, 2022
Article in press: January 17, 2022
Published online: February 19, 2022
ARTICLE HIGHLIGHTS
Research background
Antipsychotic medication is widely prescribed to patients with dementia displaying neuropsychiatric symptoms. The present study investigated the risk of antipsychotics on mortality in all forms of dementia including vascular dementia. It is anticipated the findings will help inform clinical practice and contribute to the development of training packages on prescribing antipsychotics in dementia.
Research motivation
Antipsychotic prescribing in older adults must be made with caution as there are age related changes in pharmacokinetics and pharmacodynamics that can result in an increased sensitivity to drugs and their side effects. Similarly, the concerns around the safety and effectiveness of aripiprazole, olanzapine, quetiapine and risperidone (four specific antipsychotics) have been also raised for older patients in a clinical trial setting. Usage of antipsychotics in this population has increased despite regulatory warnings from the Food and Drug Administration and the European Medicines Agency.
Research objectives
This study was developed with a primary objective to evaluate the impact of atypical antipsychotics associated with mortality in a dementia cohort.
Research methods
A retrospective clinical cohort study was designed to review data from electrical health records (RIO system) gathered over a 5-year period (January 1, 2013 to December 31, 2017) in a National Health Service setting.
Research results
Treatment with olanzapine and risperidone was associated with an increased mortality risk. In comparison, olanzapine showed a relatively lower non-significant association with the mortality risk in those with dementia.
Research conclusions
Clinicians within primary and secondary care need to be aware of the potential heterogeneous relationship between dementia, antipsychotic medication and mortality when creating a psychopharmacological treatment plan for their patients.
Research perspectives
Future comprehensive investigation is imperative, especially in understanding how the sub-diagnoses of dementias differ in their medication interactions and the effect of biological differences in sex and ethnicity that many intervene and further elucidate our findings.
