Long‐term antipsychotic use and cognitive decline in community‐dwelling older adults with mild–moderate Alzheimer disease: Data from NILVAD.
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| Title: | Long‐term antipsychotic use and cognitive decline in community‐dwelling older adults with mild–moderate Alzheimer disease: Data from NILVAD. |
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| Authors: | Dyer, Adam H. (AUTHOR), Murphy, Claire (AUTHOR), Lawlor, Brian (AUTHOR), Kennelly, Sean P. (AUTHOR), for the NILVAD Study Group (AUTHOR) |
| Source: | International Journal of Geriatric Psychiatry. Nov2021, Vol. 36 Issue 11, p1708-1721. 14p. |
| Subjects: | Older people, Alzheimer's disease, Dementia |
| Abstract: | Introduction: Previous evidence has suggested that antipsychotic use may be associated with accelerated cognitive decline in those living with dementia. However, the cognitive effects of long‐term antipsychotic use in community‐dwelling older adults with mild–moderate Alzheimer disease (AD) has not been explored to date. Methods: We assessed the impact of long‐term antipsychotic use on the rate of cognitive decline (Alzheimer's Disease Assessment Scale—Cognitive Subsection) and dementia progression (Clinical Dementia Rating—Sum of Boxes [CDR‐Sb]/Disability Assessment for Dementia [DAD]) over 18 months in older adults with mild–moderate AD. Results: Of 509 participants with mild–moderate AD, one‐tenth (54/509; 10.6%) were prescribed an antipsychotic for the 18‐month study duration. Antipsychotic use was significantly associated with accelerated cognitive decline at both 12 (β: 3.53, 0.91–6.17, p = 0.008) and 18 months (β: 3.81, 0.49–7.14, p = 0.024) in addition to greater dementia progression at both 12 (β: 1.85, −0.97–2.73, p < 0.001 for CDR‐Sb/β: −3.33, −5.56–1.10, p = 0.003 for DAD) and 18 months (β: 1.41, 0.16–2.67, p = 0.027 for CDR‐Sb/β: −3.86, −6.64 to −1.08, p = 0.006 for DAD). APOEε4 carriers experienced significantly greater cognitive decline with long‐term antipsychotic use. Conclusions: Long‐term antipsychotic use was associated with greater cognitive decline and dementia progression in community‐dwelling older adults with mild–moderate AD. Our findings are consistent with previous evidence encouraging cautious and careful consideration of risks versus benefits of antipsychotic usage in those with AD. Key Points: The cognitive effects of long‐term antipsychotic use in mild–moderate Alzheimer disease (AD) are unclearOne in 10 community‐dwelling older adults with mild–moderate AD were prescribed a regular antipsychotic medicationAntipsychotic use was associated with greater cognitive decline and dementia progression in mild–moderate ADEffects were particularly pronounced for carriers of the APOEε4 allele [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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