UCSF

Objective: This study examines associations between the use of atypical antipsychotics (AA) and mortality in persons diagnosed with Alzheimer's disease (AD) and behavioral and psychological symptoms of dementia (BPSD). Background: Data on the use of AAs for behavioral and psychological problems experienced by persons with AD have shown higher risk for mortality, yet continue to be prescribed to ameliorate severe symptoms. Methods: Retrospectively matched pair case control using a three year survival analysis based on the duration to death from first diagnosis of AD with BPSD for those who were prescribed and not prescribed AAs. Propensity score matching created treatment and case controls based on acuity and estimated probability to use AAs. Setting: An integrated managed care organization (MCO) consortium in Northern California between the years 2001 and 2008.

Participants: 3,140 AD patients with BPSD, 1,570 AA treatment cases and 1,570 non-AA control cases. Measurements: Kaplan-Meier and Cox proportional hazards analysis stratified by AA users and non-users. Results: AA use in AD patients with BPSD is associated with lower risk of death than AA non-use in adjusted models when controlling for congestive heart failure, hypertension, the presence of a pacemaker, acute renal failure and cancer (HR = 0.699, 95% CI = [0.632-0.772], p < 0.0001). Patients with a history of using more than one AA over the course of BPSD have lower risk than patients only using one medication (HR = 0.682, 95% CI = [0.59-0.79], p = <.0001). Dosage strength greater than the minimum strength recommended does not afford higher risk (HR = 1.123, 95% CI = [0.957-1.319], p = 0.1557), non-full compliance is lower risk than full compliance (HR = 0.682, 95% CI = [0.59-0.79], p = <.0001) and one-time prescriptions are higher risk than non-use (HR = 1.428, 95% CI = [1.121-1.818], p = 0.0039). Conclusions: This study provides evidence that AD patients with BPSD taking AAs have lower risk for death than non-users when controlling for cardiovascular risk factors, pacemakers, renal failure and cancer. The data may suggest mortality risk can be further reduced by careful medication management.