Wolfson Centre for Age-Related Diseases, Wolfson Wing, King's College London, Guy's Campus, Hodgkin Building, London, UK.
Expert Opin Drug Saf. 2011 Jan;10(1):35-43. doi: 10.1517/14740338.2010.506711. Epub 2010 Aug 5.
Many people with Alzheimer's disease (AD) and other dementias are prescribed atypical antipsychotics for behavioral and psychiatric symptoms such as aggression and psychosis. Recent evidence has highlighted safety concerns regarding antipsychotics in these individuals.
We summarize the evidence pertaining to efficacy and safety from short-term randomized controlled trials (up to 12 weeks), key findings from case-register studies and more detailed discussion of longer term outcome studies, including longer term mortality risk of antipsychotics in AD.
The review aims to provide a balanced and up to date overview of the efficacy and safety concerns related to atypical antipsychotics in people with AD, in particular providing a detailed overview of mortality risk, and a personal interpretation of the implications and recommendations for the way forward.
Atypical antipsychotics confer modest benefits for short-term (up to 12 weeks) treatment of aggression and psychosis in AD. These benefits have to be balanced against the risk of serious adverse events including 1.5 - 1.8-fold increased mortality. The benefits are less clear-cut with longer term prescribing, but the mortality risk remains significantly elevated. Pharmacogenetics may provide an opportunity to more effectively focus prescribing in the future.
许多患有阿尔茨海默病（AD）和其他痴呆症的人因行为和精神症状（如攻击和精神病）而被开处方使用非典型抗精神病药物。最近的证据强调了这些人群中使用抗精神病药物的安全性问题。
我们总结了短期随机对照试验（长达 12 周）中与疗效和安全性相关的证据，病例登记研究中的关键发现，以及对更长期结局研究的更详细讨论，包括 AD 患者使用抗精神病药物的长期死亡率风险。
本综述旨在提供一个平衡且最新的有关 AD 患者使用非典型抗精神病药物的疗效和安全性问题的概述，特别是对死亡率风险进行详细概述，并对其影响和建议进行个人解读，以确定未来的发展方向。
非典型抗精神病药物在治疗 AD 患者的短期（长达 12 周）攻击和精神病方面具有适度的益处。这些益处必须与严重不良事件的风险相平衡，包括死亡率增加 1.5-1.8 倍。在长期用药方面，益处不那么明显，但死亡率风险仍然显著升高。药物遗传学可能为未来更有效地集中用药提供机会。
