A review on mortality risks associated with antipsychotic use in behavioral and psychologic symptoms of dementia (BPSD)

INTRODUCTION: As the population ages, the prevalence rate of behavioral and psychologic symptoms of dementia (BPSD) rises, and there appears to be an increasing need for pharmacologic treatment where nonpharmacologic treatment would not suffice. Most clinicians are well aware of the increased risks of cerebrovascular event and mortality from antipsychotic use in older adults with dementia. Nevertheless, mortality risks reported in various publications still vary considerably and lack consistency to allow direct comparison between individual drugs. METHODS: A literature search was conducted for primary and secondary sources of evidence regarding the mortality risks associated with antipsychotic use in BPSD. RESULTS: Available evidence suggests that antipsychotics are indeed associated with elevated risks of cerebrovascular adverse events and mortality. There is also evidence suggestive of a varied risk among individual agents, and a dose-response as well as a time-response relationship. DISCUSSION: This review aims to provide an updated overview of the publications available on mortality data and risks associated with antipsychotic dose and duration of use. Confounders and limitations are discussed to allow clinicians to better make judgment calls on assessing risks and benefits when treating BPSD with an antipsychotic.