Findings from psychiatrists working at one of Cavendish Square Group member trusts, Camden and Islington NHS Foundation Trust, could lead to safer and more effective prescribing of a widely-used anti-psychotic drug to treat Alzheimer’s patients.
Risperidone - the only antipsychotic drug licensed for the treatment of people with dementia - is prescribed to treat symptoms of dementia which can include delusions, aggression and agitation.
However, various clinical trials have shown that the risk of stroke and death is significantly raised in dementia patients who are prescribed the drug, making many doctors reluctant to use it.
Now, Professor Rob Howard and colleague, Dr Sergi Costafreda, have been able to identify the individual characteristics of those patients most likely to have a stroke or to die as a result of taking Risperidone.
Together with colleagues from Janssen, the company that makes Risperidone, they studied data from six separate trials involving 1,723 patients.
They found that patients whose symptoms did not include delusions, were almost six times more likely to have a stroke with Risperidone, compared to those patients given a placebo.
However, in patients who had delusions at the point of commencing treatment, Risperidone did not significantly increase the risk of having a stroke.
Professor Howard, Honorary Consultant Psychiatrist at Camden and Islington NHS Trust and Professor of Old Age Psychiatry at University College London said: “This is vitally important information for prescribing doctors – delusions in dementia are distressing and disruptive to the lives of patients and their caregivers.
“Knowing that the presence of these highly treatable symptoms marks a group of dementia patients who are not at increased risk of stroke with risperidone can help doctors to more clearly evaluate the risks and benefits of treatment.
“Whilst we do not yet have treatments to cure or slow down the progression of Alzheimer’s disease, it is really important to make the most of the treatments that we do have that can improve symptoms and the lives of patients and their families.”
It is hoped that Professor Howard’s findings will address an under-treatment of psychosis symptoms.
Dr James Pickett, Head of Research at the charity Alzheimer’s UK, said: “It is vital that people with dementia receive high quality care that’s right for them.
“Professor Howard’s study helps us to unpick who might benefit from taking Risperidone, indicating that those who use it for psychological symptoms such as depression and delusions have fewer side effects.
“Antipsychotics are not a one-size-fits-all solution – they can have severe side effects and using them inappropriately to manage behaviour can be extremely damaging for people with dementia”.
Professor Howard’s work fits into the Trust’s pledge to value research, to use evidence-based interventions and to provide outcomes that matter to our service-users – three of the ten pledges that form part of the Trust’s new Clinical Strategy (which is set out in full here).
Professor Howard’s work was supported by the National Institute for Health Research Queen Square Dementia Biomedical Research Unit.