March 30, 2007
Nigel Hawkes, Health Editor
Drugs commonly prescribed to people with Alzheimer’s disease are accelerating their deaths by an average of six months, a study has found.
Up to 45 per cent of people with Alzheimer’s in nursing homes are given sedative drugs known as neuroleptics to try to control behavioural symptoms such as aggression.
In severe cases, the drugs may be justified. But a five-year study by the Alzheimer’s Research Trust showed that, as well as reducing life expectancy, they were of no benefit to patients with mild symptoms and were associated with significant deterioration in verbal fluency and cognitive function.
Clive Ballard, professor of age-related disorders at King’s College London, who presented the findings at the charity’s conference in Edinburgh yesterday, said: “It is very clear that even over a six-month period of treatment there is no benefit of neuroleptics in treating the behaviour in people with Alzheimer’s disease when the symptoms are mild.
“For people with more severe behavioural symptoms, balancing the potential benefits against increased mortality and other adverse events is more difficult, but this study provides an important evidence base to inform this decision-making process.”
Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “These results are deeply troubling and highlight the urgent need to develop better treatments.
“Seven hundred thousand people are affected by dementia in the UK, a figure that will double in the next 30 years. The Government needs to make Alzheimer’s research funding a priority. Only £11 is spent on UK research into Alzheimer’s for every person affected by the disease, compared with £289 for cancer patients.”
The study examined 165 people with Alzheimer’s living in nursing homes in Oxford-shire, Newcastle upon Tyne, Edinburgh and London. They had been taking neuroleptic drugs for at least three months and took part in a trial in which some were taken off the drugs and others were not. The drugs involved were thioridazine (Melleril), chlorpromazine (Largactil), haloperidol (Serenace), trifluoperazine (Stelazine) and risperidone (Risperdal).
Follow-ups in succeeding years showed striking differences in survival. After two years survival was 78 per cent in those taken off the drugs, and 55 per cent in those still on them. After three years the figures were 62 per cent against 35 per cent, and at 42 months 60 per cent against 25 per cent.
Neil Hunt, chief executive of the Alzheimer’s Society , said: “Neuroleptics have been used as a dangerous fix for ‘challenging behaviour’ in people with dementia for too long.
“These drugs have now been exposed as having no benefit for people with dementia, while causing a dramatic increase in the risk of death. It is a disturbing revelation that confirms some of our worst fears about neuroleptics, which have been the subject of numerous health warnings.
“It is a national scandal that people are being sedated in this way. These drugs must be a last resort only used when all other methods have failed to alleviate the most distressing symptoms of dementia.”
— More than 700,000 people in Britain have dementia, and about half of these suffer from Alzheimer’s disease
— The drugs in the study do not treat the disease, but can reduce some of the more extreme behavioural symptoms in severe cases
— Three drugs that do treat the disease are licensed for use in mild to moderate cases: Aricept, Reminyl and Exelon. The government drug watchdog, the National Institute for Health and Clinical Excellence, recommends that only those with moderate — ie, more severe — symptoms should get these drugs on the NHS
— Survival after a diagnosis of Alzheimer’s is very variable, and depends on how severe the symptoms are at the time of diagnosis. One US study found average survival for men was 4.2 years and for women 5.7 years