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Saturday, January 10, 2009

Alzheimer's drugs double death risk

Use of Fluoride containing anti-psychotics included in this study. Another issue to consider above most for problems with Alzheimer's disease.

Fluoride suppresses proper function of the thyroid gland. As I have mentioned elsewhere, 67% of people in Alzheimer's care facilities in 1998 had a thyroid disorder. Anyone on long term use of a fluoride containing drug, in an area where fluoride is forced into the municipal water system, is already on fluoride overload.

I guess I wonder where are those asking the right questions...
Alzheimer's drugs double death risk in elderly
By MARIA CHENG, AP Medical Writer
Thu Jan 8, 2009

LONDON – 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.

On the Net:
Copyright © 2009 The Associated Press. All rights reserved

The Lancet Neurology, Early Online Publication, 9 January 2009
Longterm Risk of Death for Alzheimer's and Use of Antipsychotics
Editors' note: Antipsychotics do not improve cognitive or neuropsychiatric outcomes in most patients with dementia, and serious concerns have been raised about their side effects in the very old. Increased mortality rate and risk of cerebrovascular events have been reported by previous studies of relatively short duration (usually 12 weeks). In this article, the DART-AD investigators report long-term mortality rates among patients with Alzheimer's disease in residential care after 12-months of neuroleptic treatment, adding to the growing evidence against the use of antipsychotics in this vulnerable population.

The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial.

Original Text: Clive Ballard MD a , Maria Luisa Hanney PhD b, Megan Theodoulou MRCPsych c, Simon Douglas BSc d, Rupert McShane MRCPsych e, Katja Kossakowski BSc a, Randeep Gill MBBS a, Edmund Juszczak MSc f, Ly-Mee Yu MSc f, Robin Jacoby DM c, for the DART-AD investigators

Background: Data from 12-week placebo-controlled trials have led to mounting concerns about increased mortality in patients with Alzheimer's disease (AD) who are prescribed antipsychotics; however, there are no mortality data from long-term placebo-controlled trials. We aimed to assess whether continued treatment with antipsychotics in people with AD is associated with an increased risk of mortality.

Methods: Between October, 2001, and December, 2004, patients with AD who resided in care facilities in the UK were enrolled into a randomised, placebo-controlled, parallel, two-group treatment discontinuation trial. Participants were randomly assigned to continue with their antipsychotic treatment (thioridazine, chlorpromazine, haloperidol, trifluoperazine, or risperidone) for 12 months or to switch their medication to an oral placebo. The primary outcome was mortality at 12 months. An additional follow-up telephone assessment was done to establish whether each participant was still alive 24 months after the enrolment of the last participant (range 24—54 months). Causes of death were obtained from death certificates. Analysis was by intention to treat (ITT) and modified intention to treat (mITT).

This trial is registered with the Cochrane Central Registry of Controlled Trials/National Research Register, number ISRCTN33368770.

Findings: 165 patients were randomised (83 to continue antipsychotic treatment and 82 to placebo), of whom 128 (78%) started treatment (64 continued with their treatment and 64 received placebo). There was a reduction in survival in the patients who continued to receive antipsychotics compared with those who received placebo. Cumulative probability of survival during the 12 months was 70% (95% CI 58—80%) in the continue treatment group versus 77% (64—85%) in the placebo group for the mITT population. Kaplan—Meier estimates of mortality for the whole study period showed a significantly increased risk of mortality for patients who were allocated to continue antipsychotic treatment compared with those allocated to placebo (mITT log rank p=0·03; ITT p=0·02). The hazard ratio for the mITT group was 0·58 (95% CI 0·35 to 0·95) and 0·58 (0·36 to 0·92) for the ITT population. The more pronounced differences between groups during periods of follow up longer than 12 months were evident at specific timepoints (24-month survival 46% vs 71%; 36-month survival 30% vs 59%).

Interpretation: There is an increased long-term risk of mortality in patients with AD who are prescribed antipsychotic medication; these results further highlight the need to seek less harmful alternatives for the long-term treatment of neuropsychiatric symptoms in these patients.

Funding: UK Alzheimer's Research Trust.

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