Nielsen R-E, Lolk A, Valentin J-B, Andersen K
Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Mølleparkvej 10, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Institute of Clinical Health, University of Southern Denmark, Department of Psychiatry, Odense, Region of Southern Denmark, Denmark.
Eur Psychiatry. 2017 May;42:14-23. doi: 10.1016/j.eurpsy.2016.11.013. Epub 2016 Dec 12.
Alzheimer's disease (AD), the most common disease causing dementia, is linked to increased mortality. However, the effect of antipsychotic use on specific causes of mortality has not yet been investigated thoroughly.
Utilizing the Danish nationwide registers, we defined a cohort of patients diagnosed with AD. Utilizing separate Cox regressions for specific causes of mortality, we investigated the effects of cumulative antipsychotic dosage after diagnosis and current antipsychotic exposure in the time period 2000-2011.
In total, 45,894 patients were followed for 3,803,996 person-years. A total of 6129 cardiovascular related deaths, 2088 cancer related deaths, 1620 infection related deaths, and 28 intentional self-harm related deaths are presented. Current antipsychotic exposure increased mortality rate with HR between 1.92 and 2.31 for cardiovascular, cancer, and infection related death. Cumulative antipsychotic dosages were most commonly associated with increased rates of mortality for cardiovascular and infection as cause of death, whereas the associations were less clear with cancer and intentional self-harm as cause of death.
We showed that cumulative antipsychotic drug dosages increased mortality rates for cardiovascular and infection as cause of death. These findings highlight the need for further investigations of long-term effects of treatment and of possible sub-groups who could benefit from treatment.
阿尔茨海默病（AD）是导致痴呆最常见的疾病，与死亡率增加有关。然而，抗精神病药物使用对特定死亡原因的影响尚未得到充分研究。
利用丹麦全国登记册，我们确定了一组被诊断为AD的患者队列。针对特定死亡原因使用单独的Cox回归分析，我们调查了2000年至2011年期间诊断后累积抗精神病药物剂量以及当前抗精神病药物暴露的影响。
总共对45894名患者进行了3803996人年的随访。共呈现了6129例心血管相关死亡、2088例癌症相关死亡、1620例感染相关死亡以及28例故意自残相关死亡。当前抗精神病药物暴露使心血管、癌症和感染相关死亡的死亡率增加，风险比在1.92至2.31之间。累积抗精神病药物剂量最常与心血管和感染作为死亡原因导致的死亡率增加相关，而与癌症和故意自残作为死亡原因的关联则不太明确。
我们表明，累积抗精神病药物剂量增加了心血管和感染作为死亡原因的死亡率。这些发现凸显了进一步研究治疗的长期影响以及可能从治疗中受益的亚组的必要性。
