Objective:

To evaluate the impact of duration of exposure to antipsychotic medications on the risk of cerebrovascular events (CVE) in elderly patients.

Background:

The FDA issued black box warnings for typical (1st generation) and atypical (2nd generation) antipsychotic medications (APM) regarding an increased risk of stroke and death in elderly patients with dementia. Several studies have compared the cerebrovascular risk profiles of typical and atypical antipsychotic agents in elderly patients, but the influence of duration of antipsychotic exposure on this risk remains unclear.

Design/Methods:

A comprehensive literature search was performed on PubMed in June 2022, the results of which were systematically screened using predefined inclusion and exclusion criteria. Included articles adequately controlled for confounding variables and reported on the duration of continuous exposure to APM and the risk of CVE in patients over 65. Quality assessment of the included studies was performed using the Newcastle-Ottawa scoring system.

Results:

From the 7,515 articles generated by the search, five observational studies reporting on APM duration and CVE in elderly patients were selected based on quality as they satisfied the inclusion criteria. Four studies found that long-term (> 90 days), but not short-term, use of typical APM conferred a greater CVE risk than atypical APM used for the same duration. One study including only patients with dementia did not identify a difference with short or long-term use of typical versus atypical APM.

Conclusions:

The duration of therapy with APM may influence the risk of CVE in elderly patients. Although atypical agents are associated with the development of metabolic syndrome, long-term use of typical APM may confer a greater risk of CVE than atypical APM. Differences in the risk of CVE are less salient in short-term use of APM.