Association between antipsychotics and all-cause mortality in elderly patients diagnosed with dementia with different patterns of BPSD

Dementia is a clinical syndrome characterized by progressive cognitive decline and loss of independence in activities of daily living. Alongside the cognitive symptoms, Behavioral and Psychological Symptoms of Dementia (BPSD) may arise, causing considerable distress to both patients and caregivers. Despite their use is still off-label and they are associated with several side effects, antipsychotics represent the main pharmacological strategy to alleviate BPDS. The primary objective of my study was to evaluate the possible correlation between frailty and BPSD in a population of elderly patients with dementia referred to our Memory Clinic. The second aim was to evaluate the possible correlation between antipsychotics use and all-cause mortality. The NPI scale was used in order to assess the presence and severity of BPSD. According to literature, BPSD were classified in three different clusters: “mood/apathy” (depression, apathy, sleep disturbances, appetite disturbances), ”psychosis” (delusions, hallucinations and anxiety) and “hyperactivity” (agitation, elation, motor aberrant behavior, irritability, disinhibition). The results of my study showed a significant correlation between frailty and “hyperactivity” cluster, both at baseline and follow up visits. Patients on antipsychotic therapy reported a higher mortality rate, although there is no statistically significant association between antipsychotic use and mortality. These data suggest the usefulness of an in-depth study in a larger cohort of patients with cognitive impairment and BPSD