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Prescribed drugs and deterioration in Alzheimer's disease

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39092.632419.BE (Published 08 February 2007) Cite this as: BMJ 2007;334:284

In a cohort of 224 patients with Alzheimer's disease whose disease progression was measured over 12 months, prescription of antipsychotics and sedatives hastened deterioration. Deterioration was slowed, however, by specific memory related drugs, statins, angiotensin converting enzyme inhibitors, and angiotensin II receptor antagonists.

Most harm was found in the patients who had been prescribed both antipsychotics and antidepressants—the odds ratio for rapid deterioration, compared with those prescribed neither of these drugs, was 3.86 (95% confidence interval 1.28 to 11.7). For the third of patients taking drugs indicated for dementia, the risk of deterioration was reduced (0.31, 0.11 to 0.85). Intriguingly, the effect seemed greater with antihypertensives and statins.

Causality is not proved by this study, and dosage and compliance were not considered. The main message is to weigh risk and benefit carefully before prescribing antipsychotics and sedatives. The authors are encouraged that medication licensed for Alzheimer's disease seems to slow decline, but it is sobering that statins may perform even better.

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