Antipsychotics and Mortality Risk in Parkinson’s Disease

Of patients with Parkinson’s disease (PD), 60% experience psychosis and 80% develop dementia. The use of antipsychotics to manage symptoms in this population is common.  It has been established that the use of antipsychotics in patients with dementia is associated with increased mortality, but whether this risk extends to patients with PD is unknown.  Weintraub and colleagues performed a retrospective, matched-cohort study of nearly 8,000 patients with idiopathic PD to examine this risk.

They found that patients with PD who started antipsychotic therapy were more than twice as likely to die within six months, compared with those who were not taking antipyschotics.  The conventional antipsychotic haloperidol was linked with the highest mortality risk, followed by the atypical antipsychotic agents olanzapine, risperidone, and quetiapine. 

In an accompanying editorial, a historical review of antipsychotics and reports of their increase on mortality is described. Limitations of the study are also discussed, such as lack of confidence in the diagnosis of both PD and dementia in the population and whether the diagnosis of psychosis was a contributing factor in the patient’s death, rather than the therapies used to treat it.  We also gain appreciation for the challenge of clinicians in managing symptoms in patients with dementia, with or without Parkinson’s disease, and the need for a well-designed prospective study to guide treatment recommendations.

Link to JAMA Neurology article abstract and editorial abstract (03/21/2016)