Risk of Cerebrovascular Events Associated with Antipsychotics in Dementia: A Systematic Review

Background: Antipsychotics have been used for many years for the treatment of neurological disorders, and the application of antipsychotics in the elderly have increased in frequency over the past few years. The absolute benefit of typical as well as atypical antipsychotics have come into question as their safety in elderly population is not seem to be in sync with their theoretical assessments. Purpose and Objective: To understand the various side effects, or adverse events, associated with the use of typical and atypical antipsychotics. To assess the benefits and risks of use of typical and atypical antipsychotics through risks vs. benefits, morbidity and mortality through a secondary search analysis of various randomized clinical trials. Design: The research was conducted through PubMed, MEDLINE, and Google Scholar, where keywords used to search for studies were ‘antipsychotics’, ‘dementia’, ‘elderly’, ’typical antipsychotics’, ‘atypical antipsychotics’, ‘psychosis’, ‘risks’, ‘benefit’, ‘behavioral disorders’, and ‘adverse cerebrovascular events’. Findings: 8 studies were selected for the review that matched the inclusion criteria of the study. The studies included a total of 3135 elderly patients with dementia of the Alzheimer’s type, vascular dementia and mixed dementia, with mean age 80.4 years. The studies evaluated provided the benefits of antipsychotics, their relative risks and the side effects related to cerebrovascular events. Conclusion: The findings of this study led to the understanding that there was no significant difference between typical and atypical antipsychotics in terms of efficacy, and that higher dose of antipsychotic lead to greater number of adverse events in the elderly patients. Also, cerebrovascular events was not a significant adverse event in the treatment groups, as somnolence and gait disturbances were more common and frequent than stroke and ischemic attacks. Thus, these antipsychotics pose a moderate risk in terms of cerebrovascular health of patients suffering from dementia.