School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
J Am Geriatr Soc. 2020 Mar;68(3):595-602. doi: 10.1111/jgs.16275. Epub 2020 Jan 7.
BACKGROUND/OBJECTIVES: Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer's disease (AD).
Nationwide register-based cohort study.
Medication Use and Alzheimer's Disease (MEDALZ) cohort, Finland.
The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded.
Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD-10] codes S00-S09) and traumatic brain injuries (TBIs; ICD-10 codes S06.0-S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.
Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person-years = 1.65 [95% confidence interval {CI} = 1.50-1.81] for users and 1.26 [95% CI = 1.16-1.37] for nonusers; IPT-weighted hazard ratio [HR] = 1.29 [95% CI = 1.14-1.47]) and TBIs (event rate per 100 person-years = 0.90 [95% CI = 0.79-1.02] for users and 0.72 [95% CI = 0.65-0.81] for nonusers; IPT-weighted HR = 1.22 [95% CI = 1.03-1.45]). Quetiapine users had higher risk of TBIs (IPT-weighted HR = 1.60 [95% CI = 1.15-2.22]) in comparison to risperidone users.
These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies. J Am Geriatr Soc 68:595-602, 2020.
背景/目的：抗精神病药物的使用与老年人跌倒风险相关，但我们并不清楚之前是否有研究调查过抗精神病药物使用与头部损伤风险之间的关系。我们研究了社区居住的阿尔茨海默病（AD）患者使用抗精神病药物与头部损伤风险之间的关系。
全国基于登记的队列研究。
药物使用和阿尔茨海默病（MEDALZ）队列，芬兰。
MEDALZ 队列包括芬兰社区居住者，他们在 2005 年至 2011 年期间被临床确诊患有 AD。从处方登记册中确定新使用抗精神病药物的患者，并通过年龄、性别和 AD 诊断后时间（21795 对匹配）与非使用者匹配。有既往头部损伤或精神分裂症病史的患者被排除在外。
结果是新发头部损伤（国际疾病分类，第十次修订版[ICD-10]代码 S00-S09）和创伤性脑损伤（TBI；ICD-10 代码 S06.0-S06.9）导致住院（住院登记册）或死亡（死因登记册）。使用逆概率治疗（IPT）加权 Cox 比例风险模型评估相对风险。
抗精神病药物的使用与头部损伤风险增加相关（使用者的每 100 人年事件发生率为 1.65 [95%置信区间 {CI} = 1.50-1.81]，而非使用者为 1.26 [95% CI = 1.16-1.37]；IPT 加权风险比[HR] = 1.29 [95% CI = 1.14-1.47]）和 TBI（使用者的每 100 人年事件发生率为 0.90 [95% CI = 0.79-1.02]，而非使用者为 0.72 [95% CI = 0.65-0.81]；IPT 加权 HR = 1.22 [95% CI = 1.03-1.45]）。与利培酮使用者相比，喹硫平使用者发生 TBI 的风险更高（IPT 加权 HR = 1.60 [95% CI = 1.15-2.22]）。
这些发现表明，除了先前报告的不良事件和影响外，抗精神病药物的使用可能会增加 AD 患者头部损伤和 TBI 的风险。因此，应根据 AGS Beers 标准®，将其使用限制在最严重的神经精神症状。此外，应在进一步的研究中证实喹硫平使用者与利培酮使用者相比 TBI 的相对风险更高。美国老年医学会 68:595-602, 2020.
