Predictors of mortality in atypical antipsychotic-treated community-dwelling elderly patients with behavioural and psychological symptoms of dementia: a prospective population-based cohort study from Italy

Purpose To evaluate the effect of a broad range of covariates on the survival of a real-life long-term follow-up cohort of community-dwelling patients with behavioural and psychological symptoms of dementia who were new users of atypical antipsychotic medications (APMs). Methods This was a prospective cohort study of 1,618 subjects aged ≥65 years with dementia and BPSD (“behavioural and psychological symptoms of dementia”) who were new users of atypical APMs and registered in a Dementia Evaluation Unit of Campania Region (Italy) from September 2006 to March 2010. The potential of baseline features to predict mortality was assessed with the Cox proportional hazards model. Results The average follow-up was 309 days. Of the 1,618 new users of atypical antipsychotics, 9.3 % experienced at least one adverse event, including death (5.1 %), drug therapeutic failure (3.0 %), extrapyramidal symptoms (0.5 %) and stroke (0.2 %). The crude all-cause mortality rate was 6.0 per 100 person-years [95 % confidence interval (CI) 4.8–7.4]; the rate was higher in patients aged >85 years (9.0 per 100 personyears, 95 % CI 6.4–12.7) and among male patients (7.5 per 100 person-years, 95% CI 5.3–10.6). In the multivariate analysis, only age was associated to all-cause mortality [hazard ratio (HR) 1.1; 95%CI 1.0–1.1 and HR 1.4; 95%CI: 0.9–2.2, respectively). In contrast, hallucination (HR 0.4; 95%CI 0.2– 0.6) and dosage change (HR 0.4; 95 % CI 0.2–0.78) were significantly associated with a lower risk of all-cause mortality. Conclusions Among our patient cohort, the mortality rate of patients with BPSD receiving long-term treatment with atypical APMs was lower than that reported in other studies, and only age was found to be significant predictor factor of mortality.