Atypical antipsychotics worsen cognitive function in Alzheimer’s disease

January 01, 0001

Atypical antipsychotics worsen cognitive function in Alzheimer’s disease

These US authors assessed the effects of atypical antipsychotics olanzapine, quetiapine, and risperidone on cognition in patients with Alzheimer's disease in the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease study (CATIE-AD). CATIE-AD included 421 outpatients with Alzheimer's disease and psychosis or agitated/aggressive behavior who were randomly assigned to receive masked, flexible-dose olanzapine, quetiapine, risperidone, or placebo. Based on their clinicians' judgment, patients could discontinue the originally assigned medication and receive another randomly assigned medication. Patients were followed for 36 weeks, and cognitive assessments were obtained at baseline and at 12, 24, and 36 weeks. Outcomes were compared for 357 patients for whom data were available for at least one cognitive measure at baseline and one follow-up assessment that took place after they had been on their prescribed medication or placebo for at least 2 weeks.

They found: "Overall, patients showed steady, significant declines over time in most cognitive areas, including in scores on the Mini-Mental State Examination (MMSE; -2.4 points over 36 weeks) and the cognitive subscale of the Alzheimer's Disease Assessment Scale (-4.4 points). Cognitive function declined more in patients receiving antipsychotics than in those given placebo on multiple cognitive measures, including the MMSE, the cognitive subscale of the Brief Psychiatric Rating Scale, and a cognitive summary score summarizing change on 18 cognitive tests."

The authors concluded: "In CATIE-AD, atypical antipsychotics were associated with worsening cognitive function at a magnitude consistent with 1 year's deterioration compared with placebo. Further cognitive impairment is an additional risk of treatment with atypical antipsychotics that should be considered when treating patients with Alzheimer's disease."

Another significant risk for use of atypical antipsychotics in patients with Alzheimer’s disease.

For the full abstract, click here.

Am J Psychiatry 168:831-839, August 2011 © 2011 to the American Psychiatric Association
Cognitive Effects of Atypical Antipsychotic Medications in Patients With Alzheimer's Disease: Outcomes From CATIE-AD. Cheryl L.P. Vigen, Wendy J. Mack, Richard S.E. Keefe, et al. Correspondence to Dr. Lon Schneider: [email protected]

Category: N. Neurological, P. Psychological. Keywords: Alzheimer’s disease, cognition, atypical antipsychotics, olanzapine, quetiapine, risperidone, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 30 August 2011

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