May 2005

Nursing home sufferers' illness worsened by drugs used to treat Alzheimer's

Quetiapine, a drug commonly used in nursing homes to treat agitation and related symptoms in people with Alzheimer's disease actually worsens patients' illness, speeding up their rate of decline significantly, according to a study in the British Medical Journal (BMJ).

Antipsychotic drugs are used in up to 45% of nursing homes to treat agitation, a common and distressing symptom of dementia (a catch‑all term for diseases such as Alzheimer's.) Researchers found that, when given a placebo as treatment for these symptoms, patients showed little change. Yet, those patients administered the frequently used antipsychotic drug quetiapine showed a marked worsening in the condition with noticeable deterioration of memory and other higher brain functions (cognitive decline).

The authors stated that this finding was of particular significance as quetiapine had been regarded as one of the safer of the antipsychotic drugs available. 93 dementia patients across the northeast of England were looked at over six months. Those in the study taking quetiapine experienced a doubling in cognitive decline compared with the placebo control group.

While patients taking rivatigmine, another antipsychotic in the trial, showed little or no worsening of their illness, neither was there improvement in symptoms above the placebo group. The study raised significant concern regarding the safety of quetiapine, suggesting it cannot be considered a viable alternative to either of the two most commonly used antipsychotic drugs for people with dementia ‑‑ risperidone or olanzapine ‑‑ which, the authors pointed out, themselves carry increased risk of stroke.

They argued that there are vital implications to be derived from this study. Not only should quetiapine not be used in place of other drugs for alleviating symptoms of patients with dementia, the findings also underscore concerns over long term use of antipsychotics in these patients.

SOURCE: Ballard C, et.al. "Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial," BMJ, Feb 2005.