Drugs For Psychosis Worsen Dementia

(another rewrite of information previously covered in articles I've sent out - I think this might be a little easier to understand - Brian)

Some drugs used to treat behavior problems in people with dementia may actually worsen their mental decline, researchers say.

Use of neuroleptic agents -- such as chlorpromazine, haloperidol, or thioridazine -- in 71 patients with dementia led to a doubling in the rate of decline in their mental function, according to an article published this week in the British Medical Journal. Many of the patients studied had Alzheimer's disease.

"The possibility that the cognitive function of patients with dementia could be made worse by neuroleptics has received little attention," says Dr. Rupert McShane and colleagues of Oxford University's Warneford Hospital in England.

In their report in this week's issue of the British Medical Journal, the researchers point to earlier studies showing that neuroleptics have been known to sometimes worsen behavior disturbances and increase the risk of falls and fractures in people with dementia.

The new study followed 71 elderly British men and women over a two-year period. All were living at home either with family or other caregivers.

Every four months, interviews were conducted and measurements taken to note any change in their thinking (cognitive) processes. In addition, the researchers noted any reports of aggression, hallucinations, thoughts of persecution, or disturbed night and day (diurnal) rhythms, including sleep cycles.

The researchers compared their findings in patients receiving neuroleptic drugs with those for patients not taking these drugs.

"The rate of cognitive decline in patients taking neuroleptics was twice that in those not taking neuroleptics," the authors state.

Moreover, those taking the drugs were more aggressive, had more thoughts of persecution, and had more severe disturbances of wake-sleep cycles.

According to McShane, "The results suggest that neuroleptics may make things worse, but do not prove it."

"Although our study does not prove a causal relation, we suggest there should be regular review of the need for (demented) patients to continue taking neuroleptic drugs," the authors conclude.

The study authors note that the overuse of neuroleptic drugs in U.S. nursing homes led to federal legislation prohibiting their use for behaviors such as restlessness, insomnia, wandering, or unspecified agitation. A recent study conducted in a Glasgow nursing home found that 88% of the Scottish patients were prescribed a neuroleptic drug inappropriately, according to the American guidelines.

The term "neuroleptic" comes from the Greek "neur" for nerve or nervous system and "lepsis" for "taking hold" -- literally "taking hold of the nervous system."

SOURCE: British Medical Journal (1997;314:14-18)

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