Alzheimer’s, Antipsychotics and Pneumonia: A Balancing Act

By Trevor Willingham
Sunday, January 1, 2017

Recent research finds that regardless of the drug selected, physicians should exercise caution when prescribing antipsychotics to Alzheimer’s patients.

As early as 2005, the FDA labeled pneumonia as one of the leading causes of death among those who are prescribed antipsychotics to treat symptoms of dementia. Since then, numerous studies have echoed this finding, but rarely have they focused on the risk to patients with Alzheimer’s disease (AD) specifically or on the individual risk levels associated with certain common antipsychotics.

Now, Finnish research published in the journal Chest finds that no matter which drug is chosen, antipsychotic use is associated with an elevated risk of pneumonia among Alzheimer’s patients.

Closing the Gap

“[People with AD or dementia] are at a particularly high risk of pneumonia, use antipsychotics more commonly than persons without AD or dementia, and are particularly vulnerable to adverse drug events,” says Anna-Maija Tolppanen, PhD, Associate Professor at the University of Eastern Finland. Even so, she adds, other than one small study, there has been a gap in research attempting to understand Alzheimer’s patients’ hazard level regarding antipsychotic use and pneumonia.

“The risk-benefit balance of antipsychotics should be carefully considered before prescribing them, especially for behavioral and psychological symptoms. If treatment is initiated, it would be important to monitor carefully the effects and adverse effects and to limit its duration as short as possible.”
— Anna-Maija Tolppanen, PhD, Associate Professor at the University of Eastern Finland

Drawing on data from a cohort of about 61,000 patients in Finland with clinically verified AD, she and fellow researchers studied the relationship between antipsychotic medication use and hospitalizations or deaths caused by pneumonia from 2005 to 2011. They compared those rates with those of a matching sample of people without AD.

Antipsychotic use was associated with an approximately twofold relative risk of pneumonia in the AD cohort and a somewhat higher risk among those without AD, Medscape Medical News reported.

Moreover, Tolppanen says, similar results were found no matter which of the three main antipsychotics was used: quetiapine, risperidone or haloperidol.

Proceeding with Care

Even with the pneumonia risk, researchers note that antipsychotics remain a key option for treating extreme agitation, aggression and other symptoms common among Alzheimer’s patients. A 2012 study in The New England Journal of Medicine also warns of dangers associated with an abrupt halt to antipsychotic treatment. According to the study, patients whose symptoms improved while taking certain antipsychotics had a high risk of relapsing if they were suddenly taken off the medication.

“Antipsychotics can be risky to use but may be needed in severely agitated and psychotic patients who do not respond to other interventions,” says Davangere P. Devanand, MD, MBBS, Director of Geriatric Psychiatry at Columbia University Medical Center, who was involved in that research. “It is a balance between efficacy and side effects, and generally antipsychotic medications are becoming increasingly limited to patients with severe agitation or psychosis and with less severe medical problems.”