Am J Psychiatry. 2013 Sep;170(9):1051-8. doi: 10.1176/appi.ajp.2013.12081046.
The authors sought to determine the effects of conventional and atypical antipsychotic use on time to nursing home admission and time to death in a group of outpatients with mild to moderate probable Alzheimer's disease.
The authors examined time to nursing home admission and time to death in 957 patients with the diagnosis of probable Alzheimer's disease who had at least one follow-up evaluation (mean follow-up time, 4.3 years [SD=2.7]; range, 0.78-18.0 years) using Cox proportional hazard models adjusted for age, gender, education level, dementia severity, hypertension, diabetes mellitus, heart disease, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use.
A total of 241 patients (25%) were exposed to antipsychotics at some time during follow-up (conventional, N=138; atypical, N=95; both, N=8). Nursing home admission (63% compared with 23%) and death (69% compared with 34%) were more frequent in individuals taking conventional than atypical antipsychotics. In a model that included demographic and cognitive variables, hypertension, diabetes mellitus, heart disease, incident strokes, and extrapyramidal signs, only conventional antipsychotic use was associated with time to nursing home admission. However, the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death.
The use of antipsychotic medications, both conventional and atypical, was not associated with either time to nursing home admission or time to death after adjustment for relevant covariates. Rather, it was the presence of psychiatric symptoms, including psychosis and agitation, that was linked to increased risk of institutionalization and death after adjustment for exposure to antipsychotics.
作者旨在确定在一组轻度至中度可能患有阿尔茨海默病的门诊患者中，使用传统和非典型抗精神病药物对入住养老院时间和死亡时间的影响。
作者使用 Cox 比例风险模型，对 957 名患有可能患有阿尔茨海默病的患者进行了随访评估（平均随访时间为 4.3 年[SD=2.7]；范围为 0.78-18.0 年），以调整年龄、性别、教育水平、痴呆严重程度、高血压、糖尿病、心脏病、锥体外系症状、抑郁、精神病、攻击性、激越和痴呆药物使用。
共有 241 名患者（25%）在随访期间曾使用过抗精神病药物（传统药物，N=138；非典型药物，N=95；两者均有，N=8）。使用传统抗精神病药物的患者入住养老院（63%比 23%）和死亡（69%比 34%）的比例较高。在包含人口统计学和认知变量、高血压、糖尿病、心脏病、新发中风和锥体外系症状的模型中，只有传统抗精神病药物的使用与入住养老院的时间有关。然而，在调整精神症状后，这种关联不再显著。精神病与入住养老院和死亡时间有很强的相关性，但传统和非典型抗精神病药物与死亡时间无关。
在调整相关协变量后，无论是传统还是非典型抗精神病药物的使用，都与入住养老院时间或死亡时间无关。相反，正是精神病症状的存在，包括精神病和激越，与调整抗精神病药物暴露后增加的机构化和死亡风险相关。
