Incidence of abnormal metabolic parameters and weight gain induced by atypical antipsychotics in elderly patients with dementia

Abstract

Objective: To determine if atypical antipsychotic therapy leads to the development of abnormal metabolic parameters and weight gain in elderly patients with dementia.

Design: Retrospective chart review.

Setting: Veterans Affairs Medical Center.

Patients: Veterans 65 years of age or older with the diagnosis of dementia.

Main outcome measure: The incidence of impaired fasting glucose (> 100 mg/dL) after initiation of atypical antipsychotic therapy. The secondary objectives were to determine the incidence of significant weight gain, worsening of lipid values, new onset of type 2 diabetes mellitus, and metabolic syndrome.

Results: After reviewing 979 charts for inclusion and exclusion criteria, 56 patients were found eligible for the study. More than 50% of patients were excluded because they were lacking baseline or follow-up glucose laboratory results. Ten percent of the study population developed impaired fasting glucose after starting atypical antipsychotic therapy. Overall glucose increased by 9.7 mg/dL from baseline to follow-up. Significant weight gain (>or= 7% of baseline weight) occurred in 8.92% of elderly. However, overall weight decreased by 1.3 kg during the study periods. Patients who developed worsening lipid parameters or were started on lipid-lowering therapy were 14.5% of the study population even though overall lipid levels improved or remained unchanged.

Conclusion: Periodic monitoring of glucose should be considered for patients with dementia begun on atypical antipsychotics, although aggressive monitoring may be controversial for end-stage dementia. Overall, weight reduction and improvement in lipid parameters were observed in this study. The common metabolic adverse effects noted frequently with atypical antipsychotics may not be as much of a concern with the elderly population.