Use of antipsychotics in adults with dementia

The linked study by Mok and colleagues (doi:10.1136/bmj-2023-076268) provides new insights into the risks associated with use of antipsychotics in dementia care.1 This population based matched cohort design compared the incidence of serious adverse outcomes, including stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, in adults (≥50 years) with dementia who were prescribed antipsychotics versus those who did not use antipsychotics.

Using data from the Clinical Practice Research Datalink (CPRD) database in England, the study included 35 339 adults with dementia who had just been prescribed antipsychotics for the first time, within a broader population of 173 910 adults with dementia. The authors found significantly increased risks for nearly all evaluated adverse outcomes in antipsychotic users, with especially steep increases for pneumonia (hazard ratio 2.19, 95% confidence interval 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), …