Effect of antipsychotic medication use and type on mortality and cardiovascular risks in nursing home patients with dementia

Alzheimers Dement (Amst). 2026 Jan 12;18(1):e70247. doi: 10.1002/dad2.70247. eCollection 2026 Jan-Mar.

ABSTRACT

INTRODUCTION: Antipsychotic medication (APM) use in nursing home (NH) patients with dementia is common but carries risks. This study assessed the association between APM use and mortality, stroke, and myocardial infarction (MI) compared to non-use, as well as differences between first- and second-generation APMs.

METHODS: A serial cross-sectional study using Medicare data examined outcomes from 2012 to 2015 in a national sample of 328,138 US NH residents aged 50 and older with dementia. Multivariate logistic regressions were used to analyze risk.

RESULTS: APM use was associated with increased mortality in all years (odds ratio [OR] range: 2.39 to 1.23, all p < 0.001) and stroke risk from 2012 to 2014 (OR range: 1.17 to 1.10, p < 0.01) but not MI. First-generation APMs posed a higher mortality risk than second-generation APMs, with no significant stroke or MI differences.

DISCUSSION: Findings highlight the need for cautious APM use in dementia patients in NHs due to elevated mortality and stroke risks.

HIGHLIGHTS: Study provides insights into APM risks in underrepresented nursing home (NH) dementia population.APM use in NH dementia patients is linked to higher death risk.First-generation APMs showed higher mortality risk than second-generation APMs.Overall, APM use is associated with increased stroke risk.No association was found between APM use and MI risk overall.

PMID:41536850 | PMC:PMC12795781 | DOI:10.1002/dad2.70247