Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study

Abstract

Objective: To investigate in a longitudinal cohort of people with Alzheimer's disease whether taking antipsychotics is associated with more rapid cognitive deterioration. Method: From a sample of 224 people with Alzheimer's disease recruited as epidemiologically representative, those taking antipsychotic drugs for more than 6 months were compared with those who were not, in terms of change in three measures of cognition. The effects of potential mediators and confounders (demographic factors, neuropsychiatric symptoms, cognitive severity and cholinesterase inhibitors) were also examined. Results: No significant difference was observed in cognitive decline between those taking antipsychotics (atypical or any) and others on any measure of cognition. The only predictor of more cognitive decline was greater baseline cognitive severity (B = 3.3, 95% confidence interval 0.6 to 6

Prediction of survival in Alzheimer's disease—The LASER‐AD longitudinal study

“…We did not examine the duration of illness prior to assessment as this has not been found to be a determinant of survival time when age and disease severity are taken into account, but would expect that duration of illness would be related to severity of cognitive impairment (Walsh et al, 1990;Heyman et al, 1996;Moritz et al, 1997;Larson et al, 2004). Survival was not associated with the prescription of antipsychotic or antidepresssant medication, in agreement with our previous study using the same cohort which found that antipsychotic medication was not associated with cognitive decline or survival (Livingston et al, 2007).…”

“…The derivation cohort was 224 people recruited as part of a naturalistic, longitudinal study of people with AD, covering the London and the South East Region (LASER-AD study) (Livingston et al, 2007). Local research ethics committees approved the study.…”

An overview of the LASER-AD study: A longitudinal epidemiological study of people with Alzheimer's disease

“…More than 80% of those without any of these risk factors survived at least three and a half years, while only around a third of those with three risk factors survived this long. Survival was not associated with the prescription of antipsychotic or antidepressant medication, in agreement with Livingston et al, (2007) who found that antipsychotic medication was not associated with cognitive decline or survival. There is a clear difference in the survival time of people with mild or moderate AD according to their possession of the identified risk-factors.…”

“…The areas examined in this cohort of 224 people with AD and their carers include disease detection ; predictors of progression (Fox et al, 2011;Livingston et al, 2007;Regan, et al, 2006), institutionalisation (Habermann et al, 2009) and mortality in AD (Paradise et al, 2009); costing models for AD , Rive et al, 2010aRive et al, 2010b); symptoms of AD (Train et al, 2004;Regan et al, 2005;Ryu et al, 2005) and characteristics of moderate-severe AD ; quality of life (Hoe et al, 2005;Hoe et al, 2007) and ageing well in adversity (Livingston et al, 2008). The issues affecting carers of people with AD, include psychological morbidity Maidment et al, 2005), attachment (Cooper et al, 2008a), coping Cooper et al, 2008b;Cooper et al, 2008c), safety in AD (Walker et al, 2006), carer attributions of behaviour in AD (Paton et al, 2004) and elder abuse in AD (Cooper et al, 2008d).…”

“…However, having a cerebrovascular accident during the 18-month follow-up period contributed considerably to the rate of deterioration in cognition and functioning along with stopping acetylcholinesterase-inhibitors (AChEIs). Livingston et al, (2007) undertook a comparison of those taking antipsychotic drugs for more than 6 months compared with those who were not, in terms of change in three measures of cognition and whether in naturalistic circumstances where those who do badly may stop antipsychotics, as opposed to randomised controlled trials. The effects of potential mediators and confounders (demographic factors, neuropsychiatric symptoms, cognitive severity and AChEIs) were examined.…”