Great Catch-22 here; if your doctor can't prevent your post stroke dementia, they could cause another stroke. So, ask your competent? doctor FOR EXACT DEMENTIA PREVENTION PROTOCOLS! NO excuses allowed!
And your doctor knew of this last year, right?
Your risk of dementia, has your doctor told you of this? Your doctor is responsible for preventing this!
1. A documented 33% dementia chance post-stroke from an Australian study? May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.`
3. A 20% chance in this research. July 2013.
4. Dementia Risk Doubled in Patients Following Stroke September 2018
The latest here:
Risperidone Use in Dementia Linked to Increased Stroke Risk Regardless of CVD History
The antipsychotic risperidone is associated with increased stoke risk in older adults with dementia, even in those without cardiovascular disease (CVD), results of a large population-based study showed.
“We knew that risperidone increased risk of stroke; however, there were no major studies examining whether this risk differed according to the clinical history of the patient,” co-first author Byron Creese, PhD, Department of Psychology, Brunel University of London, Uxbridge, England, told Medscape Medical News.
“We found that the relative risk of stroke associated with risperidone was the same across all subgroups. In this respect, we could say there is no ‘safer’ group to give risperidone to, at least when it comes to clinical history,” Creese said.
The study was published online on October 9 in The British Journal of Psychiatry.
Similar Stroke Risk Across All Groups
Up to 50% of individuals living with dementia experience agitation or aggression during the course of the illness. While nondrug interventions are recommended as first-line treatment, antipsychotics such as risperidone are often used when symptoms are severe.
Until now, little was known about risperidone influenced stroke risk in patients with and without a history of CVD.
To find out, the researchers compared the incidence of stroke in adults living with dementia who were prescribed risperidone with that of a matched control group across subgroups of patients with and without a prior history of stroke and other types of CVD.
Using the UK Clinical Practice Research Datalink, they identified 28,403 older adults who initiated risperidone after dementia diagnosis. Patients who had received other antipsychotics within 90 days before being prescribed risperidone were excluded as these medications also increase stroke risk. Each risperidone user was propensity score-matched to up to five control individuals with dementia who were not prescribed antipsychotics (n = 136,324).
Risperidone was associated with an increased risk for stroke in the overall cohort and in all subgroups over 1 year and in a 12-week sensitivity analysis.
“The principal new finding from this study was that relative risk of stroke was comparable across all subgroups,” the investigators wrote.
In the overall cohort, the unadjusted incidence rate of stroke (per 1000 person-years) was 53 in risperidone users vs 41 in control individuals. In multivariable adjusted Cox models, risperidone users had a 28% higher risk for stroke than matched control individuals (adjusted hazard ratio [aHR], 1.28).
For risperidone users and matched control individuals with a stroke history, the incidence rates for stroke were 222 and 177 per 1000 person-years, respectively (aHR, 1.23).
“Although the relative risk of 1.23 may appear modest, a baseline 1-year risk of 177 per 1000 person-years is significant, and clinicians should be mindful of prescribing a drug that increases stroke risk further in an already at-risk group,” the authors wrote.
For risperidone users and matched control individuals with no stroke history, stroke incidence rates were 29 and 22 per 1000 person-years, respectively, with an aHR of 1.34 — which was not statistically different to that of the stroke history subgroup (aHR, 1.23).
“Therefore, on average, a patient with stroke history has about the same relative risk of stroke if prescribed risperidone as a patient with no stroke history,” the authors noted.
Important New Evidence
Reached for comment, Raya Elfadel Kheirbek, MD, MPH, professor of medicine, and chief in the Division of Gerontology, Geriatrics, and Palliative Medicine, University of Maryland School of Medicine, Baltimore, said this large, real-world analysis provides “important new evidence to guide antipsychotic prescribing in dementia, particularly in relation to stroke risk.”
“While prior studies have established an association between risperidone and increased cerebrovascular events, this study offers novel insights by stratifying risk across subgroups with and without preexisting CVD or stroke,” Kheirbek told Medscape Medical News.
The findings, she said, “challenge the prevailing clinical assumption that heightened risk is largely confined to individuals with prior stroke or CVD, and emphasizes that even patients perceived as ‘low risk’ carry meaningful stroke risk with risperidone initiation,” she said.
For clinicians, Kheirbek said, the study provides “quantifiable, patient-relevant data to support more informed, individualized discussions around risk.”
The data can help “contextualize treatment decisions within each patient’s clinical narrative, particularly when considering use in populations already vulnerable to poor functional recovery after stroke,” Kheirbek said. The data also underscore the importance of short-term vigilance: risk was highest within the first 12 weeks of treatment, she noted.
“Overall, the findings support a cautious, guideline-concordant approach to risperidone prescribing — reserving it for severe symptoms that have not responded to nonpharmacological strategies, and centering decisions on both clinical evidence and patient/family priorities,” said Kheirbek.
Also commenting on the findings Badr Ratnakaran, MBBS, chair of the American Psychiatric Association Council on Geriatric Psychiatry said that the link between antipsychotic use and a higher risk of cerebrovascular events in older adults with dementia is already well recognized.
“Ideally, treatment for agitation and psychosis in dementia should begin with nonpharmacologic approaches,” said Ratnakaran, who was not involved in the study.
“These include identifying potential sources of distress, such as urinary infections, creating a calm environment, using gentle redirection, soothing music, massage, aromatherapy, and addressing sensory impairments.”
“However, if nonpharmacological measures fail to control these symptoms or in acute emergencies, antipsychotics can be used. Ideally, shared decision-making with an explanation of the black box warning of increased risk of mortality must be made with patients and/or their caregivers about the judicious use of antipsychotics for the management of behavioral and psychological symptoms of dementia,” Ratnakaran said.
“The American Psychiatric Association’s guidelines on the use of antipsychotics for the management of agitation in dementia also support a patient-centered plan in using nonpharmacological and pharmacological interventions, including antipsychotics,” Ratnakaran added.
This study had no commercial funding. Creese declared receiving consultancy fees from Milbotix Ltd and IGC Pharma. Kheirbek is an associate editor of the Journal of Gerontology Medical Sciences. Ratnakaran had no disclosures.
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