New research from the University of Eastern Finland published Jan. 7 in the Journal of the American Geriatrics Society found that antipsychotic medications were associated with a 29% increased risk of head injuries and a 22% increased risk of traumatic brain injuries in Alzheimer’s patients. While a connection between antipsychotics and increased fall risk in Alzheimer’s patients has been previously established, the team of Finnish and Swedish researchers believe that theirs is the first study to look at increased risk of head injuries and traumatic brain injuries.
Currently, only five medications are approved by the U.S. Food and Drug Administration to treat Alzheimer’s disease. Healthcare providers turn to antipsychotics such as Abilify (aripiprazole), Seroquel (quetiapine) and Risperdal (risperidone) for treating the psychological and behavioral symptoms of Alzheimer’s disease such as hallucinations, extreme agitation, and aggression. However, antipsychotics come with serious side effects such as sedation, heart arrhythmias and orthostatic hypotension that can lead to falls. (Orthostatic hypotension is a type of low blood pressure in which someone can feel dizzy, lightheaded or even faint as they go from sitting to standing.) Antipsychotics are typically FDA approved to treat schizophrenia, bipolar disorder, major depressive disorder, autism, and other serious mental health conditions. When they’re prescribed for Alzheimer’s disease they’re being used off-label, meaning without FDA approval for Alzheimer’s disease, although the Alzheimer’s Association does acknowledge these medications as a valid treatment for individuals who have been appropriately informed of the risks of going off-label.
The risk of head injuries and brain injuries was greatest at the start of antipsychotic treatment and was significantly higher overall for Seroquel users compared with Risperdal users.
This was a cohort study of 43,590 Finnish individuals with a confirmed Alzheimer’s diagnosis, half of whom took antipsychotics and half of whom didn’t. Those with schizophrenia or a prior history of head injury were excluded. In cohort studies, researchers look at correlations between factors such as diet, exercise, education level, gender, age and the incidence of symptoms or diseases over a specified time period.
“These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with (Alzheimer’s disease),” the authors wrote. “Therefore, their use should be restricted to the most severe neuropsychiatric symptoms.”