Antipsychotics and cognitive decline in Alzheimer’s disease: the LASER-Alzheimer’s disease longitudinal study
- 1Department of Mental Health Sciences, University College London, London, UK
- 2Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, Kent, UK
- Correspondence to: G Livingston Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW, UK;g.livingston{at}ucl.ac.uk
- Received 30 March 2006
- Accepted 20 June 2006
- Revised 3 June 2006
- Published Online First 26 June 2006
Abstract
Objective: To investigate in a longitudinal cohort of people with Alzheimer’s disease whether taking antipsychotics is associated with more rapid cognitive deterioration.
Method: From a sample of 224 people with Alzheimer’s disease recruited as epidemiologically representative, those taking antipsychotic drugs for more than 6 months were compared with those who were not, in terms of change in three measures of cognition. The effects of potential mediators and confounders (demographic factors, neuropsychiatric symptoms, cognitive severity and cholinesterase inhibitors) were also examined.
Results: No significant difference was observed in cognitive decline between those taking antipsychotics (atypical or any) and others on any measure of cognition. The only predictor of more cognitive decline was greater baseline cognitive severity (B = 3.3, 95% confidence interval 0.6 to 6.1, t = 2.4, p<0.05). Although mortality was higher in those treated with antipsychotics, this reflected their greater age and severity of dementia. The results were the same when the whole cohort was included rather than the select group with potential to change who had been taking antipsychotics continuously.
Conclusions: In this, the first cohort study investigating the effects of atypical antipsychotics on cognitive outcome in Alzheimer’s disease, those taking antipsychotics were no more likely to decline cognitively over 6 months. Although clinicians should remain cautious when prescribing antipsychotic drugs to people with Alzheimer’s disease, any increase in cognitive deterioration is not of the magnitude previously reported. There is a need for cohort studies that follow up patients from first prescription in clinical practice for a period of months rather than weeks to determine “real-life” risks and benefits.
- ADAS-cog, Alzheimer’s Disease Assessment Scale—Cognitive Subscale
- MMSE, Mini-Mental State Examination
- NPI, Neuropsychiatric Inventory
- RCT, randomised controlled trial
- SIB, severe impairment battery
Footnotes
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Published Online First 26 June 2006
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Funding: We would like to thank Lundbeck SA for funding the data collection for the whole project. Lundbeck has neither seen nor has any knowledge of this paper.
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Competing interests: None.
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This project has been reviewed and approved by the appropriate ethics committees. The lead ethics committee was Camden and Islington community research ethics committee. It was also approved by the Barnet, Haringey and Enfield, and West Essex committees.
