The relationship between antipsychotic treatment and quality of life for patients with dementia living in residential and nursing home care facilities

Abstract

For any treatment, the impact on quality of life (QoL) is a key consideration. These issues are particularly important in the pharmacologic management of behavioral and psychological symptoms in patients with dementia (BPSD). Although these symptoms can be very distressing for some patients, the overall relationship of the symptoms with QoL is far less clear. In addition, although antipsychotic agents have moderate efficacy in the short- to medium-term management of these symptoms, it cannot be assumed that symptom resolution automatically equates with improved QoL. This is of particular concern in light of the adverse side effect profiles of many of these agents. Indeed, the only empirical study in this area conducted to date indicated that antipsychotics are associated with a worse QoL for nursing home patients. Unfortunately, none of the placebo-controlled trials of antipsychotics for the treatment of BPSD have included formal QoL measures, although preliminary evidence indicates that atypical antipsychotics such as quetiapine may result in QoL improvements. The inclusion of systematic QoL measures in future clinical trials is imperative in order to provide evidence to enable the clinician to make informed judgments regarding the potential benefits or risks of pharmacologic treatment for individual patients. In addition, such information will facilitate a better understanding of the likely factors that may contribute to the impact of treatment on QoL (e.g., side effects) and hence enable physicians to make rational treatment choices between different pharmacologic agents.