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Recent Health Canada warnings suggested
an increased risk of mortality in dementia patients treated
with atypical antipsychotics such as risperidone, olanzapine,
and quetiapine. In a meta-analysis that included published and
unpublished RCTs, Schneider et al concluded that indeed,
there was a small but statistically significant increase in
deaths in patients treated with atypical antipsychotics compared
with placebo. In a large, retrospective cohort study, Wang et
al demonstrated that elderly patients treated with typical
antipsychotics, such as haloperidol, had statistically significantly
higher mortality than patients treated with atypical antipsychotics.
It appears that while treatment of BPSD with atypical antipsychotics
may slightly increase the risk of mortality, use of typical
antipsychotics may increase this risk even more.
Risk of death with atypical antipsychotic
drug treatment for dementia: meta-analysis of randomized placebo-controlled
trials
(JAMA 2005;294:1934-1943)
LON S. SCHNEIDER, MD, MS,
KAREN S. DAGERMAN, MS,
PHILIP INSEL, MS,
LOS ANGELES, CA
Risk of death in elderly users of
conventional vs. atypical antipsychotic medications
(N ENGL J MED 2005;353:2335-2341)
PHILIP S. WANG, MD, DRPH,
SEBASTIAN SCHNEEWEISS, MD,
JERRY AVORN, MD,
MICHAEL A. FISCHER, MD,
ET AL,
BOSTON, MA
WHEN SHOULD THE ELDERLY STOP
DRIVING?
There is great interest in predicting
the risks associated with agerelated impairments. Examples of
publications in this field include prediction of driving cessation
in older adults (Anstery et al ) and how to measure performance
(Ball et al). In the case of patients with early Alzheimer’s
disease, there is debate about whether a road test should be
done routinely at the time of diagnosis and at intervals thereafter.
Predicting driving cessation over
5 years in older adults: psychological wellbeing and cognitive
competence are stronger predictors than physical health
(J AM GERIATR SOC 2006;54:121-126)
KAARIN J. ANSTEY, PHD,
TIMOTHY D. WINDSOR, PHD,
MARY A. LUSZCZ, PHD,
GARY R. ANDREWS, MB, BS
ADELAIDE, CANBERRA, AUSTRALIA
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