Raivio Minna M, Laurila Jouko V, Strandberg Timo E, Tilvis Reijo S, Pitkälä Kaisu H
Memory Research and Treatment Centers Finland-Medical Center Hemo Oy, Lahti, Finland.
Am J Geriatr Psychiatry. 2007 May;15(5):416-24. doi: 10.1097/JGP.0b013e31802d0b00.
Antipsychotics are widely used to manage behavioral disorders in patients with dementia. Recently, serious concerns have been raised about the stroke and mortality risk of atypical antipsychotics when administered to patients with dementia.
The aim of this study was to examine the impact of atypical and conventional antipsychotics on mortality and hospital admissions among Finnish elderly institutionalized patients with dementia in a two-year follow up and to compare their prognosis with that of nonusers.
The authors examined 254 very frail patients with dementia, mean age 86 years, from seven Finnish nursing homes and two hospitals in 1999-2000. Medical records provided information on the use of daily antipsychotic medication; central registers confirmed mortality for up to two years.
Nearly one-half (48.4%) of the patients used antipsychotic medication: 37.4% received conventional neuroleptics (N = 95) and 11.0% received atypical antipsychotics (N = 28). The mean number of hospital admissions was higher among the nonusers than among the users of conventional or atypical antipsychotics. Of the users of atypical antipsychotics (risperidone, olanzapine), 32.1% died within 2 years. The respective figures for users of conventional neuroleptics were 45.3%, and for the nonusers, 49.6%. In the Cox proportional hazard model, a high number of medications and the use of physical restraint predicted higher mortality at two years. The use of atypical antipsychotics showed lower risk of mortality, if any. The respective test for conventional antipsychotics was nonsignificant.
Among these frail and very old patients with dementia, neither the use of atypical antipsychotics nor the use of conventional neuroleptics increased mortality or hospital admissions. The use of restraints, however, doubled the risk of mortality.
抗精神病药物被广泛用于治疗痴呆患者的行为障碍。最近，对于将非典型抗精神病药物用于痴呆患者时的中风和死亡风险，人们提出了严重关切。
本研究的目的是在一项为期两年的随访中，考察非典型和传统抗精神病药物对芬兰老年痴呆住院患者死亡率和住院率的影响，并将他们的预后与未使用者进行比较。
作者对1999 - 2000年来自芬兰7家疗养院和2家医院的254名极度虚弱的痴呆患者进行了研究，平均年龄86岁。医疗记录提供了每日抗精神病药物使用情况的信息；中央登记处确认了长达两年的死亡率。
近一半（48.4%）的患者使用抗精神病药物：37.4%接受传统抗精神病药物（N = 95），11.0%接受非典型抗精神病药物（N = 28）。未使用者的平均住院次数高于使用传统或非典型抗精神病药物的患者。在使用非典型抗精神病药物（利培酮、奥氮平）的患者中，32.1%在2年内死亡。使用传统抗精神病药物的患者相应比例为45.3%，未使用者为49.6%。在Cox比例风险模型中，用药数量多和使用身体约束预示着两年时死亡率更高。使用非典型抗精神病药物显示出较低的死亡风险（如果有风险的话）。传统抗精神病药物的相应检验无统计学意义。
在这些极度虚弱的老年痴呆患者中，使用非典型抗精神病药物和传统抗精神病药物均未增加死亡率或住院率。然而，使用约束措施使死亡风险加倍。
