Antipsychotic medications linked to brain injuries in individuals with Alzheimer’s disease

Summary: People with Alzheimer’s disease who use antipsychotic medications have a 29% higher risk of head injury, and a 22% increased risk of TBI compared to those with the neurodegenerative disease who do not use the medications.

Source: Wiley

Use of antipsychotic medications was associated with an increased risk of head injuries in a study of individuals with Alzheimer’s disease. The findings are published in the Journal of the American Geriatrics Society.

The nationwide study of individuals in Finland who were diagnosed with Alzheimer’s disease from 2005 to 2011 included 21,795 patients who started taking antipsychotic medications and 21,795 patients who did not. Use of antipsychotic medications was linked with a 29% higher risk of head injuries–the “event rate” was 1.65 vs. 1.26 per 100 person-years in users vs. non-users. (This means there would be an average of 1.65 vs. 1.26 injuries among 100 people over one year. This translates to 165 vs. 126 injuries per 10,000 people.) Also, the use of antipsychotic medications was linked with a 22% higher risk of traumatic brain injuries–0.90 vs. 0.72 per 100 person-years.

When comparing antipsychotic medications, quetiapine users had a 60% higher risk of traumatic brain injuries compared with risperidone users.

This shows an older lady
When comparing antipsychotic medications, quetiapine users had 60% higher risk of traumatic brain injuries compared with risperidone users. Image is in the public domain.

“Persons with Alzheimer’s disease have a higher risk of falling, head injuries, and traumatic brain injuries and worse prognosis after these events in comparison to those without Alzheimer’s disease. Therefore, it is important to avoid further increasing risk with antipsychotics in this vulnerable population, if possible,” said lead author Vesa Tapiainen, MD, of the University of Eastern Finland.

About this neuroscience research article

Source:
Wiley
Media Contacts:
Penny Smith – Wiley
Image Source:
The image is in the public domain.

Original Research: Closed access
“The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer’s disease”. Vesa Tapiainen MD, Piia Lavikainen PhD, Marjaana Koponen PhD, Heidi Taipale PhD, Antti Tanskanen PhD, Jari Tiihonen MD, PhD, Sirpa Hartikainen MD, PhD, Anna‐Maija Tolppanen PhD.
Journal of the American Geriatrics Society doi:10.1111/jgs.16275.

Abstract

The Risk of Head Injuries Associated With Antipsychotic Use Among Persons With Alzheimer’s disease

BACKGROUND/OBJECTIVES
Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer’s disease (AD).

DESIGN
Nationwide register‐based cohort study.

SETTING
Medication Use and Alzheimer’s Disease (MEDALZ) cohort, Finland.

PARTICIPANTS
The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded.

MEASUREMENTS
Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD‐10] codes S00‐S09) and traumatic brain injuries (TBIs; ICD‐10 codes S06.0‐S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.

RESULTS
Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person‐years = 1.65 [95% confidence interval {CI} = 1.50‐1.81] for users and 1.26 [95% CI = 1.16‐1.37] for nonusers; IPT‐weighted hazard ratio [HR] = 1.29 [95% CI = 1.14‐1.47]) and TBIs (event rate per 100 person‐years = 0.90 [95% CI = 0.79‐1.02] for users and 0.72 [95% CI = 0.65‐0.81] for nonusers; IPT‐weighted HR = 1.22 [95% CI = 1.03‐1.45]). Quetiapine users had higher risk of TBIs (IPT‐weighted HR = 1.60 [95% CI = 1.15‐2.22]) in comparison to risperidone users.

CONCLUSIONS
These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies.

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