Alzheimer's Drugs Double Death Risk

Experts Say Anti-Dementia Drugs Are Dangerous, Overused

(AP)  Anti-psychotic drugs commonly used to treat Alzheimer's disease may double a patient's chance of dying within a few years, suggests a new study that adds to concerns already known about such medications.

"For the vast majority of Alzheimer's patients, taking these drugs is probably not a worthwhile risk," said Clive Ballard, the paper's lead author, of the Wolfson Centre for Age-Related Diseases at King's College London.

"Would I want to take a drug that slightly reduced my aggression but doubled my risk of dying? I'm not sure I would," Ballard said.

The research was published Friday in the medical journal Lancet Neurology.

Alzheimer's disease is the most common cause of dementia and causes symptoms including aggression, delusions and hallucinations. Previous studies have shown anti-psychotic drugs, which can help control the aggression and hallucinations for a few months raise the risk of death in older patients with dementia. There are other side effects, including respiratory problems and stroke.

Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer's disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos.

Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia.

After two years, 46 percent of Alzheimer's patients taking the anti-psychotics were alive, versus 71 percent of those not on the drugs. After three years, only 30 percent of patients on the drugs were alive, versus 59 percent of those not taking drugs.

In the United Kingdom and the United States, guidelines advise doctors to use anti-psychotic drugs cautiously and temporarily. But in many nursing homes in Europe and North America, up to 60 percent of patients with dementia are routinely given the drugs for one to two years.

"The drug regimen for any person with Alzheimer's needs to be personalized," said William Thies of the Alzheimer's Association in the U.S. Thies was not connected to the study. "At some points, some people will be better off with no medication."

Simon Lovestone of the Institute of Psychiatry at King's College in London said psychiatrists should try environmental or behavioral therapies instead of anti-psychotics.

Experts aren't sure how the anti-psychotics increase patients' risk of dying. But they think the drugs could be damaging to the brain and their sedative effects make patients less able to exercise and more susceptible to deadly infections.

The study was paid for by the U.K. Alzheimer's Research Trust. Ballard reported receiving grants from various pharmaceutical companies which make drugs used to treat Alzheimer's patients.

[richbear39]

SOYLENT GREEN ANYONE?

[oldpilot954]

The only ones that win in prolonging the life of a person with Alzheimers are the care facilities that take all of the family inheritance. Certainly we want to carefully consider what we give but the person is going to die within a few years. For me, staying more mentally capable until the end would be far preferable to being unable to walk, communicate, feed myself, etc. for a longer period of time.

[brainteaser2]

So what! You have an incurable disease if the available drugs provide a year or two of additional relatively normal functioning at the cost of several additional years of living in a diaper, not knowing anyone, with drool on my face I''ll take it gladly.

[k9sr4me-2009]

my mom has dementia/alzheimer''s disease and i''m her caregiver. after living with this for quite some time now, if i were to get it, i''d rather take the drug and go quickly, than linger on. it''s horrible. only those that have gone down the road i''m on can fully understand.

[rushlimpdrug]

Ahh, gee, I forgot wat i wz gna pssst.

[brannigon]

Alzheimer''s Drugs Double Death Risk? When is this going to stop! People are not lab rats! The government needs to do something about the FDA! They''re killing people; not helping them! This is insane!!!

[runningralph]

If a person can''t feed themselves, go to a toilet, or perform any useful task, and are completely out of touch with reality, what reason is there to prolong their life? I ask because I could be there myself soon. Many at my age(71)are already there.

[biomegaly]

I believe the findings are speculative at best. This is a controlled group and nearly as many patients on the placebo died as did the patients taking the antipsychotics. Also, these patients died of pneumonia per the article. As we age, it becomes increasingly more difficult to swallow. It is likely these patients developed pneumonia by aspirating (choking on thin liquids). Small particles enter the lungs causing an infection.

Families must weigh the pros and cons. As an individual in the medical field, it''s risk is valid. It is very difficult to cope at times for the families of people with Alzheimers and dementia; due to their aggitation. It''s a miracle when the drug begins to help.

[tincup356]

given time the FDA will end up poisoning most of us peddling the wishes of the pharmaceutical giants.

[lf1952]

You are missing the point here.

NO ONE says that ALL patients should get anti-psychotic meds for Alzheimer''s. Probably, VERY few should get them, and then LATE in the process and then only by clinicians specializing in Alzheimer''s. However, a trial of giving them for marked agitation/aggression (and a "trial" implies that the meds are then stopped and the behavior between the two compared) will do no harm.

Leaving patients on any medication without a good reason is always wrong. Patients simply don''t do on "auto-pilot".

Withholding medication because of a ridiculously small study is likewise wrong.

Refusing to *try* a medication that an HCP with extensive experience suggests, based on what happened to ANOTHER patient is also inappropriate. Even if you believed that this study proved something - I don''t - IF one of this class medication provides a potential benefit and no short term risk (this study does not show any short term risk) there is no reason to withhold it.

That all said, just because this study is so under-powered as to be of little help, does NOT mean it''s wrong.

[lf1952]

You are missing the point here.

NO ONE says that ALL patients should get anti-psychotic meds for Alzheimer''s. Probably, VERY few should get them, and then LATE in the process and then only by clinicians specializing in Alzheimer''s. However, a trial of giving them for marked agitation/aggression (and a "trial" implies that the meds are then stopped and the behavior between the two compared) will do no harm.

Leaving patients on any medication without a good reason is always wrong. Patients simply don''t do on "auto-pilot".

Withholding medication because of a ridiculously small study is likewise wrong.

Refusing to *try* a medication that an HCP with extensive experience suggests, based on what happened to ANOTHER patient is also inappropriate. Even if you believed that this study proved something - I don''t - IF one of this class medication provides a potential benefit and no short term risk (this study does not show any short term risk) there is no reason to withhold it.

That all said, just because this study is so under-powered as to be of little help, does NOT mean it''s wrong.

[dawnyval]

dawnyval cont: I now understand that there is no treatment for this end stage psycho-motor aggitation. It is the deep ugliness of the Alzheimers process. Just walking her and allowing her to pace and move as she needed was the treatment of choice just like my sister tried to tell me. Our relationship took a blow and it is still being repaired. It was supposedly experts on Alzheimers leading me to this decision. I know they think they are trying to help and people want a pill to stop this but they should be honest and explain this will not make this better.Just like Antibiotics do not cure a cold, these meds do not work for Alzheimers and now I know that by experience. I asked for help they gave me something, but they have to see these meds do not work and I agree that we should not just keep giving them. Education is the key here. I know this is not good news for the Alzheimers caregivers, but it is causing harm. These meds have serious side effects and the longer they are on them the more at risk they are for the bad side effects. So I pledged to First Do NO HARM. If they do not help then we risk the harmful side effects, so why do we give them. Educate, Educate!

[dawnyval]

dawnyval cont: The meds never worked on her aggitation. It was the disease process taking place. But she got lots of the nasty side effects from these drugs. I thought I was making an informed, merciful decision and I was wrong. These meds work for mental illness, but not for Alzheimers. The process of these two illnesses are different and had my sister sat me down and explained that to me I might have not given them. I wanted to help and I fear I made her worse. I regret it. But I know I did what I thought was best for her. I wanted to try to give her releif from her mental agony. My agony is that help never came. If another of my family members get this I will not give those meds.

[dawnyval]

cont: dawnyval: She was in a Psych ward the last month and a half of her life and we tried everything, but the Pcych-motor aggitaion never got better, but she deteriorated fast. All of the Alzheimers pt''s in this place looked just like her. My Aunt had it also and they followed the same path. My sister was right.

[dawnyval]

My mother died last Nov. She had Alzheimers for 8 years. I am a Neuroscience Nurse with years of experience and my sister is a Neurologist. In the last year of her life when she began to have some irritability I agreed to start some of these drugs. A well respected psychiatrist referred to me by the Alzheimers asso. began to help me with her aggitation. My sister begged me not to give her these meds because she said they will not help her only make her worse. I was her POA and I thought I was making the best decision for her. In the last 6 months of her life the aggitation increased and we gave her every one of these meds and she only got worse.

[lf1952]

BTW, to reiterate the key point.
This "study" is so small as to be (almost) statistically meaningless. I am truly amazed that Lancet would touch it with a ten foot (3m) pole.

[lf1952]

BTW, to reiterate the key point.
This "study" is so small as to be (almost) statistically meaningless. I am truly amazed that Lancet would touch it with a ten foot (3m) pole.

[lf1952]

I have to disagree with Dr. Hamlett:

(1) I know of no validated way to MEASURE quality of life in Alzheimer patients, but presumably the more functional the patient is, the better. I know of no evidence that these widely used medications don''t improve function. My experience is that they do. They also improve the safety of care-givers while avoiding restraints.

(2)It is exceptionally rare that an Alzheimer''s patient is treated by a psychiatrist. So we are mixing apples and oranges.

(3) Failure to accept that most mental illness is of organic origin predates MY medical training (i.e. 1978) and there is plenty of evidence that (best example) SSRI''s are very effective despite having no effect other than changing the behavior of neurotransmitters. That said, there is a kernel of truth to his comment - we do NOT have any anti-psychotic drugs that work with the specificity of SSRI''s.

(4) There is no evidence that I know of regarding respiratory depression with anti-psychotic medications.

(5) The REASON to patent a drug is to make money. If there is a plant out there that reverses dementia. and is not patented, then it is available to all. PLEASE tell us what this plant is!

[lf1952]

I have to disagree with Dr. Hamlett:

(1) I know of no validated way to MEASURE quality of life in Alzheimer patients, but presumably the more functional the patient is, the better. I know of no evidence that these widely used medications don''t improve function. My experience is that they do. They also improve the safety of care-givers while avoiding restraints.

(2)It is exceptionally rare that an Alzheimer''s patient is treated by a psychiatrist. So we are mixing apples and oranges.

(3) Failure to accept that most mental illness is of organic origin predates MY medical training (i.e. 1978) and there is plenty of evidence that (best example) SSRI''s are very effective despite having no effect other than changing the behavior of neurotransmitters. That said, there is a kernel of truth to his comment - we do NOT have any anti-psychotic drugs that work with the specificity of SSRI''s.

(4) There is no evidence that I know of regarding respiratory depression with anti-psychotic medications.

(5) The REASON to patent a drug is to make money. If there is a plant out there that reverses dementia. and is not patented, then it is available to all. PLEASE tell us what this plant is!

[kenhamlett]

The drugs have always been a way to make a few bucks without actually working very hard to assist the victim. The current drugs can not and do not really improve the quality of life.
The funny part is that it is becoming obvious to everyone except the shrinks that their drug pushing is the wrong approach but that is all they are able to offer. They are still clueless about causes and cures and a lot of the research is on the wrong track. They are doing the same old gambit. Find drugs to mask the symptoms but heaven forbid that they actually find a way to cure someone.

There are known compounds that have immediately reversed the dementia but only for a short time. Unfortunately I have seen NO research to extend the reversal or actually make the person permanently and stably cured.
I even know of one drug company that has tried to patent a plant used for millennia so that no one else has incentive to try it for Alzheimer''s