Evidence map›Paper›PMID 38168729›Full record

Trial reportEuropean geriatric medicine2024

Long-term antipsychotic use, orthostatic hypotension and falls in older adults with Alzheimer's disease.

Adam H Dyer, Claire Murphy, Helena Dolphin, Laura Morrison, Robert Briggs, Brian Lawlor, Sean P Kennelly, NILVAD Study Group

Abstract readClinical Trial
PubMed Publisher
In one paragraph

Trial report in European geriatric medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
3.4field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Review
  6. Huntington's Disease and Dentistry: A Review of Its Etiology, Clinical Presentation, Symptomatic Pharmacotherapy, and Dental Management.Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Adam H DyerTallaght Institute for Memory and Cognition, Tallaght University Hospital, Dublin, Ireland. dyera@tcd.ie.ORCID http://orcid.org/0000-0003-1356-510X
Claire MurphyTallaght Institute for Memory and Cognition, Tallaght University Hospital, Dublin, Ireland.
Helena DolphinTallaght Institute for Memory and Cognition, Tallaght University Hospital, Dublin, Ireland.
Laura MorrisonTallaght Institute for Memory and Cognition, Tallaght University Hospital, Dublin, Ireland.
Robert BriggsSt Mercer's Institute for Research on Ageing, St James's Hospital, Dublin, Ireland.
Brian LawlorGlobal Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
Sean P KennellyTallaght Institute for Memory and Cognition, Tallaght University Hospital, Dublin, Ireland.
NILVAD Study Group
St. Vincent's University Hospital · IETrinity College Dublin · IESt. James's Hospital · IE

Funding

Health Research Board 203930/B/16/ZWellcome Trust 203930/B/16/Z
6 · The paper itself

Abstract

purposeAntipsychotic use in Alzheimer disease (AD) is associated with adverse events and mortality. Whilst postulated to cause/exacerbate orthostatic hypotension (OH), the exact relationship between antipsychotic use and OH has never been explored in AD-a group who are particularly vulnerable to neuro-cardiovascular instability and adverse effects of medication on orthostatic blood pressure (BP) behaviour.

methodsWe analysed longitudinal data from an 18-month trial of Nilvadipine in mild-moderate AD. We assessed the effect of long-term antipsychotic use (for the entire 18-month study duration) on orthostatic BP phenotypes measured on eight occasions, in addition to the relationship between antipsychotic use, BP phenotypes and incident falls.

resultsOf 509 older adults with AD (aged 72.9 ± 8.3 years, 61.9% female), 10.6% (n = 54) were prescribed a long-term antipsychotic. Over 18 months, long-term antipsychotic use was associated with a greater likelihood of experiencing sit-to-stand OH (ssOH) (OR: 1.21; 1.05-1.38, p = 0.009) which persisted on covariate adjustment. Following adjustment for important clinical confounders, both antipsychotic use (IRR: 1.80, 1.11-2.92, p = 0.018) and ssOH (IRR: 1.44, 1.00-2.06, p = 0.048) were associated with a greater risk of falls/syncope over 18 months in older adults with mild-moderate AD.

conclusionEven in mild-to-moderate AD, long-term antipsychotic use was associated with ssOH. Both antipsychotic use and ssOH were associated with a greater risk of incident falls/syncope over 18 months. Further attention to optimal prescribing interventions in this cohort is warranted and may involve screening older adults with AD prescribed antipsychotics for both orthostatic symptoms and falls.

Indexed as

Alzheimer DiseaseAntipsychotic AgentsHypotension, OrthostaticAccidental FallsAgedAged, 80 and overFemaleHumansMaleSyncopeAntipsychotic AgentsAlzheimer diseaseAntipsychoticDementiaFallsOrthostatic hypotensionPolypharmacy

Identifiers

PMID38168729
OpenAlexW4390498022

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.