Although antipsychotic medications have been used to treat Alzheimer’s disease since the late l950’s their effectiveness has repeatedly been called into question over the years. Originally developed to minimize symptoms of agitation, mania, and psychosis in patients with schizophrenia and schizoaffective disorders most have never been formally approved by the Federal Drug Administration as a treatment protocol for the elderly population. Yet they continue to be prescribed as “off-label” medications for managing non-compliant behaviors associated with age-related forms of dementia. The jury is still out, however, on whether their overall effectiveness outweighs the potential side-effects associated with their use.
Tests repeatedly showed that first generation anti-psychotics like Haldol and Stelazine were only moderately affective in managing symptoms of agitation and mental confusion in the elderly. Instead, they induced heavy sedation and frequently increased mental confusion, placing seniors at risk for falling and fatally injuring themselves.
Within the last decade and a half, a second generation of “atypical” antipsychotics were introduced and used “off label” to treat Alzheimer’s with a slightly higher rate of effectiveness than its predecessor. Early studies showed that drugs like Zyprexa and Seroquel could be helpful in decreasing both agitation and delusional behaviors. But, more recently, atypical antipsychotics have also been contraindicated for treatment of dementia and Alzheimer’s due to their own potentially adverse effects.
Both generations of antipsychotics have been linked to troubling side effects that have resulted in many health professionals advocating against their continued use. First generation antipsychotics like Haldol and Stelazine have historically been linked to muscle jerks, motor tics and a serious condition called tardive dyskinesia which is characterized by uncontrollable body tremors and involuntary movements. Other common side effects include low blood pressure and a decrease in white blood cells. More recent studies have shown a correlation between first generation antipsychotics and an increased potential for cardiac arrest in the elderly.
Although second generation antipsychotics, looked more promising in initial trials, more current research suggests that the risk of severe side effects increases with longevity of use in a senior population. Second generation antipsychotics which include Zyprexa, Seroquel, and Risperdal, have been associated with a higher risk for unhealthy weight gain, stroke, and heart failure in patients being treated for Alzheimer’s and dementia.
In the elderly population there is an additional risk of increased confusion and over-sedation when antipsychotics are used to manage agitation and psychosis. The result is that while Alzheimer’s patients who receive treatment with an antipsychotic may become more manageable and less volatile, they may also experience flattened affect and increased short and long term memory loss.
In October of 2006, The New England Journal of Medicine released the results of a study conducted to consider the effectiveness of atypical antipsychotic drug treatment for Alzheimer’s when weighed against emerging safety concerns. The study concluded that the potentially negative outcomes and risks, associated with using second generation antipsychotics to treat an elderly population, cancelled out their overall effectiveness.
Physicians continue to prescribe antipsychotics to elderly patients to help family members and institutions manage troubling behaviors such as aggression, agitation, and auditory and visual hallucinations. In the meantime, there is certainly a significant body of data to raise red flags of concern over whether “managing” symptomology is putting an elderly population that is unable to advocate for itself, at considerable risk for untimely death.