Evaluating the Use of Antipsychotic Drug and Incidence of Stroke Among Patients With Dementia in the USA

OBJECTIVES: Antipsychotic drugs are used to treat agitation, aggression, and psychosis in dementia. However, their limited efficacy and safety always remained a concern when used long term. This study aims to identify risk of stroke and health resource utilization (HRU) among the dementia patients who are on antipsychotic prescriptions.

METHODS: A retrospective cohort study was conducted using electronic health records from TriNetX database 2000 to 2021 from 60 healthcare organizations across the US for participants (>18 years of age) with at least one antipsychotic prescription. Patients with and without dementia taking at least one antipsychotic for one year were compared for the outcomes: stroke and HRU (e.g.,ER admissions, and 30-days readmissions). Multivariable logistic and negative binomial regression models were utilized to measure factors associated to incidence of stroke and HRU, respectively.

RESULTS: A total of 101,583 patients were included in the final analysis. Among the dementia patients, 67% had polypharmacy (> 2 medications along with a antipsychotics). 24.3% of the dementia patients experienced stroke after their antipsychotic prescription vs 19.6% in nondementia patients. Dementia patients were more likely to suffer from stroke as compared to non-dementia patients (OR:1.6 95%CI:1.2-2.0, p< 0.01). Also, patients with antipsychotic polypharmacy had higher risk of stroke, 1.9 [1.4-2.4], p<0.04. Dementia patients taking antipsychotics utilized significantly more HRU, inpatient admission (IRR: 1.03[1.02-1.05]), ER admission (1.06[1.04-1.09]).

CONCLUSIONS: Our findings suggest that use of antipsychotics among the dementia patients may be associated with an increased risk of stroke and these patients also utilized higher HRU. Further studies are needed to understand the efficacy and safety profile of long-term use of antipsychotic drugs among dementia patients.