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Elderly patients with dementia: avoid neuroleptics if possible

Neuroleptics have an unfavourable risk-benefit balance for elderly patients with dementia.

Dementia can cause elderly patients to become agitated and neuroleptics are sometimes prescribed to alleviate behavioural disorders such as aggressiveness or agitation, despite their limited efficacy and many adverse effects (neurological, muscular, cardiovascular, etc.).

Various studies have revealed a high mortality rate in elderly dementia patients treated with neuroleptics.

A number of trials and large-scale studies have shown an increased mortality rate under neuroleptics (both traditional and so-called “atypical”), compared with patients not treated with neuroleptics: the death rate is around 1.5 times higher than in the placebo group.

Furthermore, a trial versus placebo clearly showed that halting treatment with neuroleptics reduces the overall mortality rate.

Given this body of evidence, when treating elderly patients with dementia who are agitated, it is preferable to avoid these drugs with an unfavourable risk-benefit balance and opt instead for behavioural therapy.

In particularly difficult situations where treatment with neuroleptics is still deemed to be appropriate, the treatment should be as brief as possible, and the minimum effective dose prescribed.

 ©Prescrire 1 October 2010

"Elderly dementia patients and neuroleptics: excess mortality" Prescrire Int 2010 ; 19 (109) : 210-212. (Pdf, subscribers only)

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