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Newer antipsychotic drugs do not increase risk of stroke in elderly dementia patients


Amid conflicting evidence over the cardiovascular safety of newer and increasingly popular atypical antipsychotic drugs, a new study from the Institute for Clinical Evaluative Sciences (ICES) has found that these drugs do not increase the risk of stroke in older adults with dementia, relative to older typical antipsychotics.

Atypical antipsychotics are frequently used to manage the physical aggression, agitation, and psychosis that can accompany dementia in the elderly, known as “behavioural and psychological symptoms of dementia” (BPSD).

In this study, researchers identified over 32,000 seniors with dementia in Ontario who received typical and atypical antipsychotics (14,865 and 17,845, respectively) between 1997 and 2002 to compare the number hospitalized with stroke between the two groups.

The authors found that older adults with dementia who were dispensed atypical antipsychotics did not have a significantly higher risk of being hospitalized for a stroke than those given typical antipsychotics.

“Our study has shown that atypical and typical antipsychotics are associated with a similar risk of stroke when used to treat patients with BPSD,” said lead author Dr. Sudeep Gill.

“Clinicians managing BPSD patients should initially rule out underlying medical illnesses and use of other drugs that might cause these sorts of behavioural disturbances. If dementia with BPSD is diagnosed, non-drug harm reduction strategies should be pursued first. When medications are considered necessary, there should be individual consultation between the physician and the patient and their family to decide on the best option.”

The study, “Atypical antipsychotic drugs and risk of ischaemic stroke: population-based retrospective cohort study”, appears in the Feb. 26, 2005 issue of the British Medical Journal (BMJ).

This study was supported by the Canadian Institutes of Health Research (CIHR) Chronic Disease New Emerging Team (NET) program. The NET program receives joint sponsorship from the Canadian Diabetes Association, the Kidney Foundation of Canada, the Heart and Stroke Foundation of Canada, and the CIHR Institutes of Nutrition, Metabolism & Diabetes and Circulatory & Respiratory Health.

Author affiliations: ICES (Drs. Gill, Rochon, Wodchis, Mamdani, Ms. Sykora, and Ms. Gunraj); Department of Medicine, Queen’s University (Dr. Gill); Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care (Drs. Gill and Rochon); Department of Psychiatry, Sunnybrook and Women’s College Health Sciences Centre (Dr. Herrmann); Division of Geriatric Medicine, University of British Columbia (Dr. Lee); Department of Healthcare Policy, Harvard Medical School and Harvard School of Public Health (Dr. Normand); Meyers Primary Care Institute, University of Massachusetts Medical School (Dr. Gurwitz); Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital (Dr. Marras); Toronto Rehabilitation Institute (Dr. Wodchis)

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Argles
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143

Read the Journal Article