According to a study in JAMA Neurology, antipsychotic use was associated with a significantly increased mortality risk in patients with Parkinson’s disease (PD).
Over half (60%) of patients with PD experience psychosis and as many as 80% develop dementia. The use of antipsychotics in patients with dementia is associated with higher mortality but it is unclear whether this mortality risk carries over to patients with PD.
Study authors from the Philadelphia Veterans Affairs Medical Center conducted a retrospective matched-cohort study by using data from a Veterans Health Administration database (1999–2010) to assess the risk associated with antipsychotic use in a cohort of patients with idiopathic PD and recent stable physical health. They compared the rates of 180-day mortality in patients who initiated antipsychotic therapy and those who did not use antipsychotics.
A total of 7,877 matched pairs of patients with PD were included in the study population. The findings showed that antipsychotic use more than doubled the hazard ratio (HR) of death vs. nonuse (HR 2.35, 95% CI: 2.08–2.66; P<0.001). Specifically, the HR was significantly higher for patients who used typical vs. atypical antipsychotics (HR 1.54, 95% CI: 1.24-1.91; P<0.001).
Of the atypical antipsychotics studied, the HR compared to nonuse of antipsychotics was 2.79 (95% CI: 1.97–3.96) for olanzapine, 2.46 (95% CI: 1.94–3.12) for risperidone, and 2.16 (95% CI: 1.88–2.48) for quetiapine fumarate.
Studies in the future should investigate the role of nonpharmacologic strategies in managing psychosis in patients with PD. Also, study findings call for the development of new pharmacologic therapies that do not raise mortality risk in patients with neurodegenerative diseases.
For more information visit jamanetwork.com.