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Cognitive effects of atypical antipsychotics in patients with Alzheimer's disease and comorbid psychiatric or behavioral problems: a retrospective study.
Clin Ther. 2006 Oct; 28(10):1695-700.CT

Abstract

BACKGROUND

In addition to cognitive decline, 30% to 40% of patients with Alzheimer's disease (AD) experience concomitant psychiatric and behavioral complications, such as hallucinations, delusions, and aggression. Atypical antipsychotics (AAs) are used to treat psychosis and aggressive behaviors in these patients; however, data regarding their early effects on cognition are conflicting. Based on a literature search, the cognitive effects of long-term treatment with AAs in outpatients with AD have not been studied.

OBJECTIVE

The aim of this study was to describe and compare the rate of cognitive decline with longterm AA use in adult patients with AD receiving concomitant treatment with cholinesterase inhibitors.

METHODS

This study was conducted at the Department of Neurology, The Ohio State University, Columbus, Ohio. Data were collected from the charts of adult outpatients who (1) received care at Memory Disorders Clinic, Columbus, Ohio, between April 2003 and June 2005; (2) were aged > or =55 years with a diagnosis of mild to severe definite or probable AD; (3) received an AA for > or =6 months or did not receive any AA; and (4) received a cholinesterase inhibitor during the entire evaluation period. Cognitive function, as measured using the Mini-Mental State Examination (MMSE), was compared between those who received AA treatment and those who did not. The end point was the rate of decline in cognitive function, defined as annualized change in mean MMSE score from baseline to the end of follow-up.

RESULTS

Ninety-two outpatients were included in the final analysis (67 women, 25 men; mean age, 72.4 years). Thirty-four patients received treatment with an AA for 6 > or =months (mean duration of treatment, 421 days) and 58 did not receive any AA treatment. Quetiapine (mean dose, 67 mg/d) was prescribed to 28 (82 %) of the patients receiving an AA. The AAs were prescribed for psychosis (15 [44%] patients), psychosis/agitation (11 [32%]), and agitation/aggression (8 [24%]). The baseline mean MMSE scores in patients receiving and not receiving an AA were 14.65 and 17.88, respectively (P = 0.021), with mean (SD) annual rates of cognitive decline of 3.03 (1.84) and 2.24 (1.27), respectively (P = NS).

CONCLUSION

The results from this retrospective study of data from a small, selected group of outpatients with AD did not find a significant difference in the rate of cognitive decline between those who received an AA for > or =6 months and those who did not.

Authors+Show Affiliations

College of Pharmacy, The Ohio State University, Columbus, Ohio 43210, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17157125

Citation

Caballero, Joshua, et al. "Cognitive Effects of Atypical Antipsychotics in Patients With Alzheimer's Disease and Comorbid Psychiatric or Behavioral Problems: a Retrospective Study." Clinical Therapeutics, vol. 28, no. 10, 2006, pp. 1695-700.
Caballero J, Hitchcock M, Scharre D, et al. Cognitive effects of atypical antipsychotics in patients with Alzheimer's disease and comorbid psychiatric or behavioral problems: a retrospective study. Clin Ther. 2006;28(10):1695-700.
Caballero, J., Hitchcock, M., Scharre, D., Beversdorf, D., & Nahata, M. C. (2006). Cognitive effects of atypical antipsychotics in patients with Alzheimer's disease and comorbid psychiatric or behavioral problems: a retrospective study. Clinical Therapeutics, 28(10), 1695-700.
Caballero J, et al. Cognitive Effects of Atypical Antipsychotics in Patients With Alzheimer's Disease and Comorbid Psychiatric or Behavioral Problems: a Retrospective Study. Clin Ther. 2006;28(10):1695-700. PubMed PMID: 17157125.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive effects of atypical antipsychotics in patients with Alzheimer's disease and comorbid psychiatric or behavioral problems: a retrospective study. AU - Caballero,Joshua, AU - Hitchcock,Michael, AU - Scharre,Douglas, AU - Beversdorf,David, AU - Nahata,Milap C, PY - 2006/06/06/accepted PY - 2006/12/13/pubmed PY - 2007/2/14/medline PY - 2006/12/13/entrez SP - 1695 EP - 700 JF - Clinical therapeutics JO - Clin Ther VL - 28 IS - 10 N2 - BACKGROUND: In addition to cognitive decline, 30% to 40% of patients with Alzheimer's disease (AD) experience concomitant psychiatric and behavioral complications, such as hallucinations, delusions, and aggression. Atypical antipsychotics (AAs) are used to treat psychosis and aggressive behaviors in these patients; however, data regarding their early effects on cognition are conflicting. Based on a literature search, the cognitive effects of long-term treatment with AAs in outpatients with AD have not been studied. OBJECTIVE: The aim of this study was to describe and compare the rate of cognitive decline with longterm AA use in adult patients with AD receiving concomitant treatment with cholinesterase inhibitors. METHODS: This study was conducted at the Department of Neurology, The Ohio State University, Columbus, Ohio. Data were collected from the charts of adult outpatients who (1) received care at Memory Disorders Clinic, Columbus, Ohio, between April 2003 and June 2005; (2) were aged > or =55 years with a diagnosis of mild to severe definite or probable AD; (3) received an AA for > or =6 months or did not receive any AA; and (4) received a cholinesterase inhibitor during the entire evaluation period. Cognitive function, as measured using the Mini-Mental State Examination (MMSE), was compared between those who received AA treatment and those who did not. The end point was the rate of decline in cognitive function, defined as annualized change in mean MMSE score from baseline to the end of follow-up. RESULTS: Ninety-two outpatients were included in the final analysis (67 women, 25 men; mean age, 72.4 years). Thirty-four patients received treatment with an AA for 6 > or =months (mean duration of treatment, 421 days) and 58 did not receive any AA treatment. Quetiapine (mean dose, 67 mg/d) was prescribed to 28 (82 %) of the patients receiving an AA. The AAs were prescribed for psychosis (15 [44%] patients), psychosis/agitation (11 [32%]), and agitation/aggression (8 [24%]). The baseline mean MMSE scores in patients receiving and not receiving an AA were 14.65 and 17.88, respectively (P = 0.021), with mean (SD) annual rates of cognitive decline of 3.03 (1.84) and 2.24 (1.27), respectively (P = NS). CONCLUSION: The results from this retrospective study of data from a small, selected group of outpatients with AD did not find a significant difference in the rate of cognitive decline between those who received an AA for > or =6 months and those who did not. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/17157125/Cognitive_effects_of_atypical_antipsychotics_in_patients_with_Alzheimer's_disease_and_comorbid_psychiatric_or_behavioral_problems:_a_retrospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(06)00248-7 DB - PRIME DP - Unbound Medicine ER -