Antipsychotics given to patients with Alzheimer’s disease to help control symptoms such as agitation and aggression may not only be ineffective for treating such problems, but may actually worsen other elements of the condition, recent UK research suggests.

The long-term study of the impact of antipsychotics in elderly patients with dementia, published in the journal Public Library of Science Medicine, was designed to assess whether using antipsychotics to treat neuropsychiatric symptoms is effective, or if any symptoms of the condition were exacerbated by such treatment.

The researchers took patients living in nursing homes across England who had been taking antipsychotics for at least three months and split them into two groups, with one continuing treatment as before and the other being switched to a placebo. They found that, at both six and 12 months, there were no statistically-significant differences between both arms of the trial in terms of cognitive decline or change in the number of neuropsychiatric symptoms, throwing the effectiveness of treatment with antipsychotics in this setting into serious doubt. Moreover, they found a significant decline in verbal fluency in patients taking antipsychotics compared to those on a ghost pill.

It was therefore suggested that, given the questions over efficacy and the side effects associated with antipsychotics, other “safer management approaches” should be used for the treatment of neuropsychiatric symptoms. Furthermore, the researchers stressed the need for further work “to examine the effects on different aspects of cognitive function, to clarify the differential impact of individual [antipsychotic] drugs, and to determine whether the impact upon cognition is sufficient to interfere with everyday activities”.

Waste of money?
Commenting on the findings, Neil Hunt, chief executive of the Alzheimer’s Society, said: “More than half of all people with dementia experience behavioural symptoms as part of their condition. Alzheimer's Society research has shown that basic dementia training can help staff deal with these symptoms and reduce the use of antipsychotics drugs by 50%. It is time we stop wasting money giving people drug treatments with no benefit and start investing in good quality dementia care”.

He went on to say that a report from the first parliamentary inquiry into the overuse of these drugs is due to be published next month, and stressed: “It is vital the government acts now to address this serious issue. Antipsychotics should only be given to a person with dementia as a last resort in the short term, when all other treatment options fail”.