By Chris Adams

When people hear of a diagnosis of dementia, they most commonly associate it with a decline in memory. But the disease can also cause severe changes in mood or personality, as well as agitation or aggression.

To deal with those symptoms, some health care providers prescribe – and often over-prescribe – antipsychotic drugs.

In a session with National Press Foundation fellows, Lori Achman of the U.S. Government Accountability Office detailed the use of antipsychotics in elderly dementia patients, as well as the steps the government is taking to reduce it.

“Antipsychotic drugs should be a last resort,” Achman said. “They should only be used if the patient is a threat to themselves or others.”

Antipsychotic drugs are used to treat schizophrenia and bipolar disorder. They are not approved to treat the behavioral symptoms than can come with dementia, but doctors are allowed to prescribe them that way if they think an “off-label” use is medically beneficial.

The problem, investigators have found, is that some nursing homes are too quick to prescribe the drugs, thus subjecting elderly patients to the risks that come with any prescription drug – particularly a powerful one such as an antipsychotic (some brand names: Risperdal, Zyprexa, Seroquel, Geodon, Abilify).

Achman’s GAO report on the issue found that such drugs have been found to increase the risk of death for older adults with a diagnosis of dementia. The drugs carry a Food and Drug Administration-required black box warning that says they are associated with higher risk of death.

They still are being used, although Achman detailed how that use has decreased.

Through an analysis of Medicare data, the GAO found that about a third of nursing home patients had some sort of dementia diagnosis; of those patients, about a third had received a prescription for an antipsychotic drug.

The GAO found that some nursing homes were simply more likely to prescribe antipsychotics, and when a new patient went to one of those homes they were 40 percent more likely to get such a prescription themselves (even after controlling for patient-specific factors).

The Centers for Medicare and Medicare Services has been pushing to reduce those numbers, with some success. In 2011, 24 percent of long-stay nursing home residents were on antipsychotics; by 2018, that had dropped to 15 percent.