Neuroleptics Enhance Cognitive Decline In Patients With Dementia
The use of neuroleptic drugs appears to hasten cognitive decline by about two fold in demented individuals. British
researchers report their finding in tomorrow's issue of the British Medical Journal.
The Warneford Hospital, Oxford, clinicians performed a 2-year prospective study in a community setting of 71 subjects with dementia. In these patients, "...the use of neuroleptic drugs was associated with an increased rate of cognitive decline in dementia." The apparent association between neuroleptic use and more rapid cognitive decline "...was independent of the degree of dementia and of the behavioural symptoms for which the neuroleptics might have been prescribed."
Although Dr. Rupert McShane, who led the study, points out that patients prescribed neuroleptics may have already been "...on a steeper trajectory of cognitive decline," he observed an increase in the rate of decline coincident with the initiation of neuroleptic therapy.
Based on necropsy evaluations, the investigators suggest that the effect may be a result of "...the anticholinergic effect of the neuroleptics." Another potential explanation is that the decrease in cognitive function may "...have been mediated by changes associated with chronic use of neuroleptics, such as enlargement of the caudate nucleus, or an increased susceptibility to develop the neurofibrillary change of Alzheimer's disease or impairment of compensatory neurotransmitter responses to neuronal degeneration."

BMJ 1997;314:266-271.

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