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Antipsychotics and mortality in Parkinsonism
Connie Marras1, Andrea Gruneir, Xuesong Wang
1Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, ON, Canada. cmarras@uhnresearch.ca
Summary
Antipsychotic drug use increases the 30-day mortality risk for older adults with parkinsonism. This study highlights a significant association, urging caution and consideration of alternative treatments for psychosis in this vulnerable population.
Area of Science:
- Geriatric Medicine
- Neurology
- Pharmacology
Background:
- Antipsychotic medication use is linked to increased mortality in elderly dementia patients.
- The specific mortality risk associated with antipsychotics in patients with pre-existing parkinsonism remains largely unknown.
Purpose of the Study:
- To investigate the risk of death within 30 days of initiating antipsychotic medications in older adults with parkinsonism.
- To compare mortality risks between different classes of antipsychotics and no antipsychotic use in this population.
Main Methods:
- A nested case-control study design was employed.
- Data were sourced from Ontario's healthcare administrative databases for individuals aged 70 years and older with parkinsonism.
- The study examined mortality within 30 days of new antipsychotic prescriptions between 2002 and 2008.
Main Results:
- Individuals with parkinsonism exposed to atypical antipsychotics showed a higher risk of death (adjusted OR: 2.0).
- Quetiapine use was associated with increased mortality compared to no antipsychotic use (adjusted OR: 1.8).
- Typical antipsychotics demonstrated a greater odds of death compared to atypical antipsychotics (adjusted OR: 2.4).
Conclusions:
- Newly prescribed antipsychotic medications are associated with an elevated 30-day mortality risk in individuals with parkinsonism.
- While causality cannot be definitively established, the findings suggest a significant increased risk.
- Clinical vigilance for co-existing conditions and exploration of alternative treatments are crucial for this patient group.
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