Reducing Use of Antipsychotics While Effectively Treating Behavioral, Psychological Symptoms of Dementia

New data from the Halting Antipsychotic use in Long Term care project (HALT) showed that it is possible to deliver effective care to patients suffering from the behavioral and psychological symptoms of dementia (BPSD) while also reducing the use of antipsychotic medications. The new data were presented at AAIC 2016 in Toronto.

“Deprescribing of antipsychotics in long-term care residents with previous BPSD is feasible without reemergence of BPSD; however, challenges still exist regarding sustainability and culture of prescribing in aged care,” presenting author Henry Brodaty, MD, DSc, of the University of New South Wales in Sydney, Australia, said in a press release. 

In order to determine the feasibility of curbing overuse of antipsychotic medications in long-term dementia care, the researchers studied a cohort of 156 dementia patients who were on regular antipsychotic treatments despite the lack of a primary psychotic illness diagnosis or severe neuropsychiatric symptoms. The patients were recruited from across 23 long-term care facilities in Australia. The researchers incrementally reduced the administration of antipsychotic medications and assessed participants at 3, 6, and, 12 months. 

The project also trained facility nurses on how to effectively administer non-pharmacological and person-centered treatments for managing behavioral and psychological episodes among dementia patients. 

Study results showed that, of the 135 study participants who achieved antipsychotic cessation to date, 76% remained free from antipsychotic medication for up to 12 months after the first reduction. Findings also showed that Neuropsychiatric Inventory and Cohen-Mansfield Agitation scores for the first 71 patients taken off of antipsychotic medications remained stabled at 6 months.

The researchers noted that, among study participants with pharmacological data available, 60% initiated their current antipsychotic regimen after admission to a long-term care facility. Brodaty and colleagues also wrote that challenges still exist regarding the culture of prescribing within long-term elder care facilities.

“Often there can be cultural and logistical barriers to moving away from antipsychotics in aged care settings, but we hope the results of this project will serve as a positive example towards a more person-centered approach globally,” Brodaty concluded. — David Costill