Issues in pharmacological management of behavioural and psychological symptoms of dementia: English ministerial review of the use of antipsychotic drugs for people with dementia

Abstract

Introduction

In response to increasing concerns about the use of anti-psychotic drugs in dementia, the Department of Health in England commissioned an independent ministerial review.

Aims and methods

The report was based upon an expert review of policy and publications; systematic review of the benefits and harms; and new pharmacoepidemiology.

Results

This review finds that these drugs are used too often in dementia and potential benefits are outweighed by their risks overall. It estimates 180,000 people with dementia receive antipsychotic medication in the UK per year. Of these, 20% (36,000) will derive some benefit. Negative effects directly attributable to antipsychotics equates to an additional 1,620 cerebrovascular adverse events (around half severe), and an additional 1,800 deaths per year. The report's analysis is that this overuse is a specific symptom of a general cumulative failure over the years in health and social care systems to develop an effective response to dementia.

Conclusions

The report contains 11 recommendations to reduce the use of these drugs to the level where benefit will outweigh risk. These include: making reduction a clinical governance priority; audit to drive down the level and up the quality of use of these drugs; specialist services to support primary care in its work in care homes and the community; research on alternatives to antipsychotic medication. The report estimates that, if this is implemented then we can reduce the rate of use of antipsychotic medication to a third of its current level safely over a 36 months.