Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, Segrate, Italy.
Dement Geriatr Cogn Disord. 2011;31(3):218-24. doi: 10.1159/000326213. Epub 2011 Apr 6.
BACKGROUND/AIMS: To evaluate whether dementia patients prescribed antipsychotic drugs have a higher mortality compared to unexposed patients, and to investigate whether there are differences in mortality associated with exposure to conventional versus atypical antipsychotic drugs.
Retrospective population cohort study with information gathered from the Italian Health Information System. All 4,369 residents of Milan (Italy) aged 60 years or older who were newly prescribed an antidementia drug (donepezil, rivastigmine or galantamine) from January 2002 to June 2008 were included. All new users of antipsychotic drugs in this cohort were categorized according to conventional (n = 156) or atypical (n = 806) drug exposure. The mortality risks of users of conventional or atypical antipsychotics compared to nonusers were evaluated with survival analysis, considering exposure to antipsychotic drugs as a time-dependent variable.
Mortality was increased two- and fivefold in users of atypical and conventional antipsychotics, respectively, with respect to nonusers.
Dementia patients prescribed antipsychotic drugs had a higher risk of death. This risk was highest for those prescribed conventional antipsychotics. At least part of the excess mortality may be due to the underlying neuropsychiatric symptoms that prompted the use of antipsychotics rather than a direct medication effect.
背景/目的：评估与未暴露于抗精神病药物的患者相比，被处方抗精神病药物的痴呆患者的死亡率是否更高，并调查与使用传统与非典型抗精神病药物相关的死亡率差异。
这是一项回顾性人群队列研究，信息来自意大利卫生信息系统。纳入 2002 年 1 月至 2008 年 6 月期间意大利米兰年龄在 60 岁及以上、新处方抗痴呆药物（多奈哌齐、利斯的明或加兰他敏）的所有 4369 名居民。根据传统（n = 156）或非典型（n = 806）药物暴露情况，将该队列中的所有新使用抗精神病药物的患者进行分类。使用生存分析评估传统或非典型抗精神病药物使用者与非使用者相比的死亡率风险，将抗精神病药物的暴露视为时间依赖性变量。
与非使用者相比，使用非典型和传统抗精神病药物的患者的死亡率分别增加了两倍和五倍。
被处方抗精神病药物的痴呆患者的死亡风险更高。对于那些被处方传统抗精神病药物的患者来说，这种风险最高。额外死亡的至少部分原因可能是促使使用抗精神病药物的潜在神经精神症状，而不是药物的直接作用。
