Stroke Risk with Risperidone in Patients with Dementia

Clinical Takeaway

: In this older cohort with dementia, risperidone was associated with greater risk for stroke, regardless of prior cardiovascular disease.

Context

Clinicians might reach for atypical antipsychotics, such as risperidone, to manage severe dementia-related agitation as an option of last resort when psychosocial interventions are too difficult to initiate in a given setting or perhaps have been tried and were ineffective. However, atypical antipsychotics are associated with heightened risk for stroke in people with dementia. Whether this risk varies based on underlying cardiovascular disease (CVD) is uncertain. These U.K. researchers retrospectively compared 28,000 older adults with dementia who initiated risperidone and 137,000 matched control patients with dementia but no antipsychotic prescriptions. Participants’ mean age was 83; 41% had known CVD, and 14% had prior strokes.