Stroke risk linked to drug actions in elderly treated with antipsychotics

Antipsychotic administration in the elderly is associated with an increased risk for cerebrovascular accident, more commonly known as stroke, according to findings from a new study.

Antipsychotics are prescribed to elderly patients to treat symptoms such as agitation, psychosis, anxiety, insomnia and depression.

In the study, published in Biological Psychiatry, researchers focused on the wide range of brain mechanisms targeted by antipsychotic medications. All antipsychotics block the D2 subtype of receptor for the neurotransmitter dopamine. However, these drugs also act on a range of other receptor targets including the serotonin 5-HT2 receptor, the M1 receptor for the transmitter acetylcholine and the alpha2 receptor for noradrenaline.

"We found that antipsychotics with a high binding affinity of alpha2 adrenergic and M1 muscarinic receptors were associated with a greater risk of stroke than the use of other types of antipsychotics," said Dr. Susan Shur-Fen Gau, Professor and Chair at National Taiwan University and corresponding author of the study.

Researchers also found that this stroke risk was elevated in patients who were older and had dementia. Stroke risk was also related to duration and dosage of treatment, with patients who received either short duration of antipsychotic treatment (four weeks or less) or higher daily doses of treatment showing an increased risk of stroke. This suggests that risk is highest in the initial weeks of antipsychotic treatment and for those with a higher average daily dose.

"Antipsychotics have a wide range of receptor profiles. The stroke risk profiles from this study suggest that it may be possible to use antipsychotics more safely in the elderly," said Dr. John Krystal, editor of Biological Psychiatry.

Additional research is necessary, but the authors recommend that clinicians start antipsychotics at low dosages and closely monitoring for side effects in the initial treatment, particularly for individuals with older age and the presence of dementia.

Patricia Sheehan

Patricia Sheehan was Editor in Chief of I Advance Senior Care / Long Term Living from 2010-2013. She is now manager, communications at Nestlé USA.