| アブストラクト | BACKGROUND: Agitation and aggression occur in up to half of people living with dementia over the course of the disease. Although non-pharmacological interventions are used as first-line treatment strategies, antipsychotics may be indicated in severe cases. A major adverse effect of antipsychotics in dementia is stroke; the mechanism of action of atypical antipsychotic risperidone has been linked to cardiovascular disease (CVD) biological pathways in preclinical studies. AIMS: To evaluate the risk of stroke associated with risperidone across different patient subgroups defined by stroke and CVD history. METHOD: Anonymised primary care data from the UK-based Clinical Practice Research Datalink were used to identify individuals diagnosed with dementia after the age of 65 years between 2004 and 2023. Risk of stroke over 1 year was compared between individuals initiating risperidone and propensity-score-matched controls across subgroups with and without history of stroke and any CVD. RESULTS: In the overall cohort (28 403 risperidone users and 136 324 mtatched controls), risperidone was associated with increased risk of stroke (adjusted hazard ratio: 1.28; 95% CI: 1.20-1.37). In the risperidone user group, the incidence rate of stroke was substantially higher in those with a prior history of stroke (incidence rate: 222 per 1000 person-years) and CVD (incidence rate: 94.1 per 1000 person-years) than in the overall cohort (incidence rate: 53.3 per 1000 person-years). Relative risks related to risperidone were similar across all CVD and stroke subgroup comparisons (hazard ratios between 1.23 and 1.44). CONCLUSIONS: People with dementia with a prior history of CVD are at a significant increased risk of stroke, and risperidone further exacerbates this risk. Moreover, risperidone increases risk of stroke in patients without a prior history of CVD. This quantification of stroke risk across subgroups with and without history of CVD may help with communication of risk and aid more judicious prescribing. |
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| ジャーナル名 | The British journal of psychiatry : the journal of mental science |
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| Pubmed追加日 | 2025/10/9 |
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| 投稿者 | Choma, Joshua; Griffiths, Alys; Henley, William; Mueller, Christoph; Williams, Nefyn; Ballard, Clive; Hopkins, Rhian; Young, Katherine G; Dennis, John M; Creese, Byron |
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| 組織名 | Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK.;Sheffield Institute for Translational Neuroscience (SITraN), Department of;Neuroscience, University of Sheffield, Sheffield, UK.;Health Statistics Group, Institute of Health Research, University of Exeter;Medical School, Exeter, UK.;Institute of Psychiatry, Psychology and Neuroscience, King's College London,;London, UK.;Department of Primary Care and Mental Health, University of Liverpool, Liverpool,;UK.;Department of Psychology, College of Health Medicine and Life Sciences, Brunel;University of London, London, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/41063545/ |
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