Kevin O'Hara-Veintimilla, J. González, Marta Lorente-Escudero, Carlota Higueras, Miguel Germán Borda
tlooto Summary
In community-dwelling older adults with dementia and NPS, no statistically significant association between antipsychotic use and all-cause mortality was observed, however, the available evidence is limited and imprecise, resulting in substantial uncertainty, and these findings should be interpreted with caution.
Abstract
OBJECTIVES Neuropsychiatric symptoms (NPS) are highly prevalent in dementia and represent a major driver of functional decline, caregiver burden, and mortality. When symptoms become severe or refractory to non-pharmacological measures, antipsychotics are frequently introduced despite ongoing safety concerns. Their impact on survival in community-dwelling patients with NPS, however, remains uncertain. This study aimed to examine the association between antipsychotic use and all-cause mortality in older adults with dementia and NPS.
METHODS This analysis was registered in PROSPERO (CRD42024621462), conducted in accordance with the Cochrane Handbook, and reported following PRISMA 2020 guidelines. Eligible observational studies included community-dwelling adults aged ≥65 years with dementia and documented NPS, reporting adjusted hazard ratios (aHRs) for antipsychotic use and all-cause mortality. Pooled estimates were derived using fixed-effects models.
RESULTS Five observational cohort studies including 14,183 participants were analyzed. Antipsychotic use was not significantly associated with all-cause mortality (pooled aHR = 1.06; 95% CI: 0.97-1.16; p = 0.21; I² = 43%). Subgroup analyses showed aHR = 0.79 (95% CI: 0.62-1.01) for typical antipsychotics and aHR = 1.23 (95% CI: 0.97-1.56) for atypical agents, with a significant difference between classes (p = 0.03).
CONCLUSIONS In community-dwelling older adults with dementia and NPS, no statistically significant association between antipsychotic use and all-cause mortality was observed. However, the available evidence is limited and imprecise, resulting in substantial uncertainty. These findings should therefore be interpreted with caution. "This study is a secondary analysis of a previously published systematic review and meta-analysis (O'Hara Veintimilla et al., 2025, Am J Geriatr Psychiatry)."
Citation format
O'HARA-VEINTIMILLA, Kevin, et al. All-cause mortality associated with antipsychotic use in people living with dementia and neuropsychiatric symptoms: Secondary analysis of a systematic review and meta-analysis. DEMENTIA AND GERIATRIC COGNITIVE DISORDERS, 2026: 1–20.