Anti-psychotics may speed Alzheimer’s...

Anti-psychotic drugs frequently used in nursing homes to treat aggression in Alzheimer’s patients don’t provide any benefit and seem to lead to a marked decline in verbal ability, a report says.

The study, published in the April issue of the journal Public Library of Science Medicine, adds to a long line of evidence suggesting such drugs aren’t safe in elderly patients and don’t work very well when used off-label.

The Food and Drug Administration warned doctors in 2005 that some anti-psychotic drugs could increase the risk of death when given to older patients in nursing homes.

Yet the drugs are widely prescribed. An estimated 30% to 60% of nursing home patients in the USA are given the drugs, and many of the patients have Alzheimer’s, a progressive brain disease that sometimes leads to aggressive behavior, says Ralph Nixon, a spokesman for the Alzheimer’s Association.

Doctors often prescribe these drugs because they act as sedatives for difficult patients, says researcher Robin Jacoby, a geriatric psychiatrist at the University of Oxford in England.

Often an underlying medical problem, such as an untreated urinary tract infection, causes an Alzheimer’s patient to behave aggressively, Jacoby says.

But overburdened doctors will prescribe a drug rather than take the time to figure out what’s causing the patient’s distress, he says. “These patients are drugged up to the eyeballs,” Jacoby says.

Jacoby and his colleagues studied 165 people with severe Alzheimer’s living in nursing homes in four cities in Great Britain, where the drugs also are heavily used. The patients had been taking an anti-psychotic drug such as thioridazine, chlorpromazine, haloperidol, trifluoperazin or risperidone for at least three months. The researchers took half the patients off the medication and gave them placebo pills. The other half kept taking the medication.

After six months, the researchers found that patients who kept taking the anti-psychotic drugs showed a significant deterioration in their ability to speak fluently. Alzheimer’s ultimately destroys the brain’s language centers, but the study suggests the drugs might speed up that process and leave patients increasingly isolated, Nixon says.

The FDA approved the anti-psychotic drugs for the treatment of schizophrenia, not Alzheimer’s, says P. Murali Doraiswamy, chief of biological psychiatry at Duke University Medical Center.

But doctors can and do prescribe FDA-approved drugs off-label for other conditions.

The medications do help certain people. If there’s no other way to stop an Alzheimer’s patient from acting out a dangerous delusion, then a prescription for an anti-psychotic can be a blessing, Doraiswamy says.

“But a lot of doctors don’t realize how powerful these drugs are,” Doraiswamy says. “They should be used only as a last resort.”