How safe are antipsychotics in dementia?

Around 800,000 people in the UK have dementia, about 80% of whom will have behavioural changes or psychological symptoms in the course of the illness. Such features lower quality of life for both patients and carers, and often result in transfer to residential care and higher costs. Currently, no drugs are licensed in the UK specifically for behavioural changes and psychological symptoms in patients with dementia. Nevertheless, antipsychotic medications have been used in people with dementia, both for psychotic symptoms and also for less specific problems such as agitation and aggression. There have been long-standing concerns about the inappropriate use of these drugs in such settings. In 2004, following worries over an increased likelihood of stroke with risperidone and olanzapine, the former UK Committee on Safety of Medicines (CSM) advised that these drugs "should not be used for the treatment of behavioural symptoms of dementia". However, this led to reports of unsuitable interpretation of the guidance, with groups of patients having their medication withdrawn inappropriately or being switched to other, potentially more harmful, drugs. Here we assess the safety of antipsychotic medication in people with dementia.