Findings from psychiatrists working at Camden and Islington Mental Health Foundation Trust could lead to safer and more effective prescribing of a widely-used anti-psychotic drug to treat Alzheimer’s patients.
Risperidone - the only antipsychotic drug licensed for the treatment of people with dementia - is prescribed to treat symptoms of dementia which can include delusions, aggression and agitation.
However, various clinical trials have shown that the risk of stroke and death is significantly raised in dementia patients who are prescribed the drug, making many doctors reluctant to use it.
Now, Professor Rob Howard and colleague, Dr Sergi Costafreda ,have been able to identify the individual characteristics of those patients most likely to have a stroke or to die as a result of taking Risperidone.
Together with colleagues from Janssen, the company that makes Risperidone, they studied data from six separate trials involving 1,723 patients.
They found that patients whose symptoms did not include delusions, were almost six times more likely to have a stroke with Risperidone , compared to those patients given a placebo. Click here to read the full research paper.
However, in patients who had delusions at the point of commencing treatment, Risperidone did not significantly increase the risk of having a stroke.
Professor Howard, Honorary Consultant Psychiatrist at Camden and Islington NHS Trust and Professor of Old Age Psychiatry at University College London said: “This is vitally important information for prescribing doctors – delusions in dementia are distressing and disruptive to the lives of patients and their caregivers.
“Knowing that the presence of these highly treatable symptoms marks a group of dementia patients who are not at increased risk of stroke with risperidone can help doctors to more clearly evaluate the risks and benefits of treatment.
“Whilst we do not yet have treatments to cure or slow down the progression of Alzheimer’s disease, it is really important to make the most of the treatments that we do have that can improve symptoms and the lives of patients and their families.”
It is hoped that Professor Howard’s findings will address an under-treatment of psychosis symptoms.
Dr James Pickett, Head of Research at the charity Alzheimer’s UK, said: “It is vital that people with dementia receive high quality care that’s right for them.
“Professor Howard’s study helps us to unpick who might benefit from taking Risperidone, indicating that those who use it for psychological symptoms such as depression and delusions have fewer side effects.
“Antipsychotics are not a one-size-fits-all solution – they can have severe side effects and using them inappropriately to manage behaviour can be extremely damaging for people with dementia”.
Professor Howard’s work fits into the Trust’s pledge to value research, to use evidence-based interventions and to provide outcomes that matter to our service-users – three of the ten pledges that form part of our new Clinical Strategy *
Professor Howard’s work was supported by the National Institute for Health Research Queen Square Dementia Biomedical Research Unit.
Notes to Editors
* Our Clinical Strategy
At the heart of everything we do are the guiding principles contained in our new Clinical Strategy launched in March 2016. The ethos behind the Piecing it Together exhibition reflects the following pledges from the Clinical Strategy:
we will co-produce with our service users and carers their treatment and support
we will work in a recovery-orientated way
we will improve access to our services for everyone regardless of gender, race, ethnicity, disability, sexual orientation and other protected characteristics
We provide mental health and substance misuse services to people living in Camden and Islington, and a substance misuse and psychological therapies service to residents in Kingston.
We have two inpatient facilities, at Highgate Mental Health Centre and St Pancras Hospital, as well as community based services throughout the London boroughs of Camden and Islington. Our Trust is also a member of University College London Partners (UCLP), one of the world’s leading academic health science partnerships.
We provide services for adults of working age, adults with learning difficulties, and older people in the London area either in a community or inpatient setting.
Our income for 2016/16 was £138million and we have approximately 1,700 staff. Our staff work in multi-disciplinary teams providing a holistic approach to recovery. This means that we often work with partner agencies and the voluntary sector.
Camden and Islington Mental Health and Social Care Trust was established in 2002. In March 2008 we became the first Care Trust to achieve Foundation Trust status and are licensed by NHS Improvement.
National Institute for Health Research (NHIR)
The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research.
The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research.
The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world.