Dementia is a progressive condition affecting cognition, emotional stability, and personality, and one of the more common methods used to treat it has come under repeated fire from the FDA. The administration recently released a report stating that older antipsychotic medications present medicated seniors with health risks severe enough to require boxed warning labels, the harshest pharmaceutical disclaimers available. While these meds were designed for the treatment of severe conditions like bipolar disorder and schizophrenia, they have for some time been prescribed off-label for dementia. Unfortunately, repeat studies demonstrate considerably higher mortality rates and cardiovascular problems among seniors taking antipsychotics.

Antipsychotic medications generally fall into two classes: older or “conventional” drugs such as Thorazine and new-generation “atypical” meds like Seroquel and Zyprexa. A 2005 report on the effects of the new drugs came to the same conclusion as this most recent release. Citing 17 studies performed across the United States and Canada, the previous report noted that death rates among medicated subjects were 1.7 times as high as those recorded in the placebo group. Causes of death were most prominently due to heart failure and infections like pneumonia. The fact that these drugs are so commonly prescribed and that none of the studies in question lasted longer than 10 weeks serves as additional cause for alarm. The long-term risks of such treatment are potentially greater. 

The latest announcement is little more than an update on that earlier report, confirming the suspected fact that neither antipsychotic group is entirely safe for dementia patients. Canadian studies examined the treatment courses of nearly 30,000 individuals aged 66 and older who had been diagnosed with dementia. Comparing the groups who used no medication with those on either atypical or conventional antipsychotics, researchers found death rates among both medicated groups to be considerably higher than in the non-medicated group, with very little variation between the two classes of drugs. A second, nearly identical study found that, after 180 days of treatment, the death rates for seniors on conventional antipsychotics were at least as high as those in the atypical group.

Researchers remain somewhat unclear as to exactly why these drugs pose such risks. The most prominent cause may be a somewhat rare side-effect, known as Long QT syndrome, wherein the heart’s electrical activity is disturbed by various internal factors that may be compounded by stress. The heart’s contraction times are thrown off by this change, and a resulting state of cardiac arrhythmia often causes heart failure and sudden death.

The physicians who prescribe these drugs to seniors may need to reconsider their practices, but they are not guilty of negligence. Symptomatic similarities between dementia and unrelated psychoses are clear, as victims of all these conditions engage in unpredictably aggressive behaviors and suffer from confusion, hallucinations, and paranoia. Because no pharmacological fix for dementia currently exists, the act of using medications designed to treat similar symptoms makes sense. Attempts to develop or identify drugs effective in the treatment of dementia have consistently frustrated researchers for some time, and while certain medications have been approved for the treatment of Alzheimer’s and other dementia-related conditions, both classes of antipsychotics have been found to work effectively for some patients.

With boxed warnings, there is the chance that prescriptions of this type will slow. Doctors are free to use their own judgment in deciding how to treat clients affected by dementia, but these reports will likely give them pause. Establishing daily living routines and offering personal support when needed are currently the safest and most effective ways to counter dementia.