Exposure to Antipsychotics and Risk of Cerebrovascular Accidents in the Demented

• Main Authors: Ching-Hui Yen, 顏靜卉
• Other Authors: Shyh-Chyun Yang
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/90013940702290247844

碩士 === 高雄醫學大學 === 藥學研究所 === 101 === Background In April 2005, based on several studies, the FDA issued a black box warning on the second generation antipsychotic drugs, indicating that the drugs may increase the risk of cerebrovascular events in elderly patients with dementia-related behavior disturbances. However, these drugs are frequently used in demented patients with behavioral and psychological symptoms. Current research rarely focuses on the first generation of antipsychotic drugs, and studies of relationships between the second-generation antipsychotics and new listing of side effects of cerebrovascular events are obscure. Objective To evaluate the risk of cerebrovascular events in elderly with dementia being treated with the first generation antipsychotics or the second generation antipsychotics in a general hospital of Southern Taiwan. Method The study cohort comprised all patients older than 65 years and registerated in the database of a general hospital in Southern Taiwan with a record of dementia history (exclued ICD-9-CM: 290.4x) from May 1, 2004 to Apr 30, 2010. Follow-up ended with hospital admission for cerebrovascular disease were identified by using ICD-9 codes 430, 431, 434, 435, 436, or the study ended (Apr 30, 2010) to define outcomes. Statistical methods include the Chi-square test, ANOVA, Kaplan-Meier survival analysis and Cox proportional hazard regression model. Results There were 512 patients enrolled. Their mean age 78.52±6.50 years, 213 were male (41.60%), and 299 were female (58.40%). 16 of 512 (3.13%) and 475 of 512 (92.77%) dementia patients were prescribed for the first and second generation antipsychotic drugs, respectively. After adjusting for confounding variables, the HR of cerebrovascular accident associated with use combined antipsychotics versus first generation antipsychotic drugs in individuals with dementia aged 65 and over older was 0.365 (95% CI = 0.097-1.369) and for use of second generation antipsychotic drugs versus first generation antipsychotic drugs was 0.133 (95% CI = 0.047-0.373). Conclusion Overall, compared to the first-generation antipsychotics, the use of the second-generation antipsychotics in the treatment causes a lower risk of cerebrovascular events. However, the longer treatment time also produces the relative increase in the cerebral vascular event risk proportion. For older people originally with cardiovascular diseases (e.g.,stroke, hypertension, diabetes, cardiac arrhythmias, etc.), they should beware of the risks.