The Risks of Antipsychotics as a Treatment for Dementia
Antipsychotics are a class of drugs that used to treat symptoms related to psychosis, including hallucinations, delusions, paranoia, and disordered thought. They are prescribed for a variety of conditions, like schizophrenia, bipolar disorder, and dementia. While generally effective, antipsychotics carry serious risks, some of which may be more severe for people with dementia.
Common Risks of Antipsychotics
Antipsychotic medications have been in use since the 1950s and a significant amount of research has since confirmed the risk of multiple adverse effects. While there are several rare but severe reactions documented (stroke, heart attack, blood clots, metabolic syndromes, etc.), a long list of common risks is perhaps the most concerning factor in relation to dementia. It includes:
- Anxiety
- Dizziness
- Headaches
- Diarrhea
- Sedation
- Weight gain
- Low blood pressure
- Blurred vision
- Sexual dysfunction
It is easy to see how many of the above symptoms can be especially troublesome for someone with dementia who may already be dealing with similar issues.
There are two other common risks of antipsychotics that may cause significant problems related to movement (which, again, may compound the symptoms already associated with several forms of dementia). These effects are less common in antipsychotics developed within the last twenty years (also known as atypical or second-generation antipsychotics). They are:
1. Extrapyramidal Side Effects
Named for their impact on the part of the nervous system that controls muscle tension, extrapyramidal side effects are a group of adverse reactions that can be induced by antipsychotic drugs. They include physical restlessness (akathisia), repetitive muscle contractions and motions (dystonia), tremors, and a condition known as parkinsonism that shares many of the same movement symptoms as Parkinson’s disease.
2. Tardive Dyskinesia
Technically another extrapyramidal side effect (because it impacts the same part of the nervous system), tardive dyskinesia is often given separate attention as a side effect of antipsychotics because it can also develop independently. It features slow, purposeless, and repetitive movements, typically of the face and mouth (grimacing, tongue flicking, lip-smacking, etc.). Tardive dyskinesia is more common in chronic antipsychotic users.
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Dementia-Specific Considerations
In addition to the risks associated with common adverse effects, research suggests that antipsychotics are linked with a higher rate of negative health outcomes for people with dementia. In at least one study, blood clots, stroke, and hip fractures were significantly more common in dementia patients who were treated with antipsychotics.
These results do not necessarily mean that antipsychotics are a direct cause of the outcomes, but it is interesting to note that blood clots and strokes are both listed as rare but severe side effects of antipsychotics.
Despite the risks, antipsychotics are still used in many dementia cases because they can effectively address some symptoms (hallucinations, delusions, mood swings, etc.) that would otherwise be untreatable. Researchers are now searching for a reliable way to determine how any given patient will respond to antipsychotic drugs.
Proceed With Caution
If antipsychotic drugs can complicate dementia during its earliest stages, then it is important for anyone who is receiving the treatment to be fully aware of their potential for developing a dementia-causing disease like Alzheimer’s or Lewy body dementia. Regular professional assessments are advisable, but a self-assessment tool like the BrainTest® app is a reliable and convenient way to screen for signs of cognitive impairments at home.
Should developing dementia be suspected, a medical professional can assess the risks associated with any current medications the person may be taking (including antipsychotics) and proceed accordingly.
