Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up.

Abstract:

OBJECTIVE:To investigate the contribution of neuroleptic drugs to cognitive decline in dementia. DESIGN:Two year prospective, longitudinal study consisting of interviews every four months, with necropsy follow up. SETTING:Community settings in Oxfordshire. SUBJECTS:71 subjects with dementia, initially living at home with informant. MAIN OUTCOME MEASURES:Cognitive function (score from expanded minimental state examination); behavioural problems (physical aggression, hallucinations, persecutory ideas, and disturbance of diurnal rhythm); and postmortem neuropathological assessment (cortical Lewy body pathology). RESULTS:The mean (SE) decline in cognitive score in the 16 patients who took neuroleptics was twice that in the patients who did not (20.7 (2.9) v 9.3 (1.3), P = 0.002). An increased rate of decline was also associated with aggression, disturbed diurnal rhythm, and persecutory ideas. However, only use of neuroleptics and severity of persecutory ideas were independently associated with more rapid cognitive decline when all other variables were adjusted for. The start of neuroleptic treatment coincided with more rapid cognitive decline: median rate of decline was 5 (interquartile range 8.5) points per year before treatment and 11 (12) points per year after treatment (P = 0.02). Cortical Lewy body pathology did not account for association between neuroleptic use and more rapid decline. CONCLUSIONS:Neuroleptic drugs that are sometimes used to treat behavioural complications of dementia may worsen already poor cognitive function. Randomised controlled trials are needed to confirm a causal relation.

journal_name

BMJ

authors

McShane R,Keene J,Gedling K,Fairburn C,Jacoby R,Hope T

doi

10.1136/bmj.314.7076.266

subject

Has Abstract

pub_date

1997-01-25 00:00:00

pages

266-70

issue

7076

eissn

0959-8138

issn

1756-1833

journal_volume

314

pub_type

杂志文章
  • Trends for prevalence and incidence of resistant hypertension: population based cohort study in the UK 1995-2015.

    abstract::Objective To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015.Design Cohort study.Setting Electronic health records from the UK Clinical Practice Research Datalink in primary care.Participants 1 317 290 users of antihypertensive drugs with...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.j3984

    authors: Sinnott SJ,Smeeth L,Williamson E,Douglas IJ

    更新日期:2017-09-22 00:00:00

  • Prevalence of microcephaly in Europe: population based study.

    abstract:OBJECTIVES: To provide contemporary estimates of the prevalence of microcephaly in Europe, determine if the diagnosis of microcephaly is consistent across Europe, and evaluate whether changes in prevalence would be detected using the current European surveillance performed by EUROCAT (the European Surveillance of Conge...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.i4721

    authors: Morris JK,Rankin J,Garne E,Loane M,Greenlees R,Addor MC,Arriola L,Barisic I,Bergman JE,Csaky-Szunyogh M,Dias C,Draper ES,Gatt M,Khoshnood B,Klungsoyr K,Kurinczuk JJ,Lynch C,McDonnell R,Nelen V,Neville AJ,O'Mahony

    更新日期:2016-09-13 00:00:00

  • Trends and comparison of female first authorship in high impact medical journals: observational study (1994-2014).

    abstract:OBJECTIVE:To examine changes in representation of women among first authors of original research published in high impact general medical journals from 1994 to 2014 and investigate differences between journals. DESIGN:Observational study. STUDY SAMPLE:All original research articles published in Annals of Internal Med...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.i847

    authors: Filardo G,da Graca B,Sass DM,Pollock BD,Smith EB,Martinez MA

    更新日期:2016-03-02 00:00:00

  • Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.

    abstract:OBJECTIVE:To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics. DESIGN:Retrospective study of the clinical records of the medical, occupational therapy, and clinical psychology departments. SETTING:20 bed unit specialising in the rehabilitation of patient...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.313.7048.13

    authors: Andrews K,Murphy L,Munday R,Littlewood C

    更新日期:1996-07-06 00:00:00

  • Systematic review and meta-analysis of ethnic differences in risks of adverse reactions to drugs used in cardiovascular medicine.

    abstract:OBJECTIVE:To review the evidence for ethnic differences in susceptibility to adverse drug reactions (ADRs) to cardiovascular drugs. DESIGN:Systematic review and meta-analysis. DATA SOURCES:We searched Medline and Embase to March 2005. Reference lists of identified articles were hand searched for further relevant arti...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1136/bmj.38803.528113.55

    authors: McDowell SE,Coleman JJ,Ferner RE

    更新日期:2006-05-20 00:00:00

  • Risk of heart failure after community acquired pneumonia: prospective controlled study with 10 years of follow-up.

    abstract::Objective To determine the attributable risk of community acquired pneumonia on incidence of heart failure throughout the age range of affected patients and severity of the infection.Design Cohort study.Setting Six hospitals and seven emergency departments in Edmonton, Alberta, Canada, 2000-02.Participants 4988 adults...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.j413

    authors: Eurich DT,Marrie TJ,Minhas-Sandhu JK,Majumdar SR

    更新日期:2017-02-13 00:00:00

  • Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in [correction of who are] carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group.

    abstract:OBJECTIVE:To investigate whether users of oral contraceptives and in [corrected] carriers of a hereditary prothrombotic condition (factor V Leiden mutation, protein C, S, or antithrombin deficiency) have an increased risk of cerebral sinus thrombosis. DESIGN:Comparison of a prospective series of cases of cerebral sinu...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.316.7131.589

    authors: de Bruijn SF,Stam J,Koopman MM,Vandenbroucke JP

    更新日期:1998-02-21 00:00:00

  • Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial.

    abstract:OBJECTIVE:To assess the effectiveness of two peritendinous autologous blood injections in addition to a standardised eccentric calf strengthening programme in improving pain and function in patients with mid-portion Achilles tendinopathy. DESIGN:Single centre, participant and single assessor blinded, parallel group, r...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,随机对照试验

    doi:10.1136/bmj.f2310

    authors: Bell KJ,Fulcher ML,Rowlands DS,Kerse N

    更新日期:2013-04-18 00:00:00

  • Avoidable waste of research related to inadequate methods in clinical trials.

    abstract:OBJECTIVE:To assess the waste of research related to inadequate methods in trials included in Cochrane reviews and to examine to what extent this waste could be avoided. A secondary objective was to perform a simulation study to re-estimate this avoidable waste if all trials were adequately reported. DESIGN:Methodolog...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.h809

    authors: Yordanov Y,Dechartres A,Porcher R,Boutron I,Altman DG,Ravaud P

    更新日期:2015-03-24 00:00:00

  • How good is general practice developmental screening?

    abstract::All developmental screening in Somerset is performed by general practitioners and health visitors. A retrospective review of a cohort of 1504 7 year old children living in semirural Somerset found that the development assessment by a health visitor at age 3 1/2 years had a sensitivity of 45% for identifying the 103 ch...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.300.6733.1177

    authors: Dearlove J,Kearney D

    更新日期:1990-05-05 00:00:00

  • Impact of growth hormone therapy on adult height of children with idiopathic short stature: systematic review.

    abstract:OBJECTIVE:To systematically determine the impact of growth hormone therapy on adult height of children with idiopathic short stature. DESIGN:Systematic review. DATA SOURCES:Cochrane Central Register of Controlled Trials, Medline, and the bibliographic references from retrieved articles of randomised and non-randomise...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,评审

    doi:10.1136/bmj.c7157

    authors: Deodati A,Cianfarani S

    更新日期:2011-03-11 00:00:00

  • Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data.

    abstract:OBJECTIVE:To use the rs1229984 variant in the alcohol dehydrogenase 1B gene (ADH1B) as an instrument to investigate the causal role of alcohol in cardiovascular disease. DESIGN:Mendelian randomisation meta-analysis of 56 epidemiological studies. PARTICIPANTS:261 991 individuals of European descent, including 20 259 c...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.g4164

    authors: Holmes MV,Dale CE,Zuccolo L,Silverwood RJ,Guo Y,Ye Z,Prieto-Merino D,Dehghan A,Trompet S,Wong A,Cavadino A,Drogan D,Padmanabhan S,Li S,Yesupriya A,Leusink M,Sundstrom J,Hubacek JA,Pikhart H,Swerdlow DI,Panayiotou

    更新日期:2014-07-10 00:00:00

  • Performance evaluation of a new rapid urine test for chlamydia in men: prospective cohort study.

    abstract:OBJECTIVE:To evaluate the performance of a rapid test for chlamydia with first void male urine samples as a potential tool for diagnosis and screening of chlamydial infection in men. DESIGN:Evaluation of test performance in prospective cohort study. Settings A young people's sexual health centre (site 1) and a genitou...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.b2655

    authors: Nadala EC,Goh BT,Magbanua JP,Barber P,Swain A,Alexander S,Laitila V,Michel CE,Mahilum-Tapay L,Ushiro-Lumb I,Ison C,Lee HH

    更新日期:2009-07-28 00:00:00

  • The New Zealand cervical cancer study: could it happen again?

    abstract::The author is one of the medical advisers to the judge who led a government inquiry into allegations that an experimental research program at the National Women's Hospital in Auckland, New Zealand, to study the natural course of cervical carcinoma in situ had withheld conventional treatment from some patients. She ar...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.297.6647.533

    authors: Paul C

    更新日期:1988-08-20 00:00:00

  • An adult with a neck lump.

    abstract::A 40 year old man presents with a 1 cm tender soft swelling in the lateral neck region. This developed seven days after the onset of a tonsillitis episode that has now resolved. He has a 20 pack-year smoking history and consumes minimal alcohol. Examination is otherwise normal. ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.f5473

    authors: Dwivedi RC,Masterson L,Alam M,Jani P

    更新日期:2013-10-28 00:00:00

  • Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study.

    abstract:OBJECTIVES:To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. DESIGN:Prospective observational study. SETTING:A newly set up SARS screening clinic in the emergency departm...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.326.7403.1354

    authors: Rainer TH,Cameron PA,Smit D,Ong KL,Hung AN,Nin DC,Ahuja AT,Si LC,Sung JJ

    更新日期:2003-06-21 00:00:00

  • Environmental tobacco smoke and risk of respiratory cancer and chronic obstructive pulmonary disease in former smokers and never smokers in the EPIC prospective study.

    abstract:OBJECTIVES:To investigate the association between environmental tobacco smoke, plasma cotinine concentration, and respiratory cancer or death. DESIGN:Nested case-control study within the European prospective investigation into cancer and nutrition (EPIC). PARTICIPANTS:303,020 people from the EPIC cohort (total 500,00...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,多中心研究

    doi:10.1136/bmj.38327.648472.82

    authors: Vineis P,Airoldi L,Veglia F,Olgiati L,Pastorelli R,Autrup H,Dunning A,Garte S,Gormally E,Hainaut P,Malaveille C,Matullo G,Peluso M,Overvad K,Tjonneland A,Clavel-Chapelon F,Boeing H,Krogh V,Palli D,Panico S,Tumino

    更新日期:2005-02-05 00:00:00

  • Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia.

    abstract:OBJECTIVE:To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture. DESIGN:Preplanned subanalysis of randomised intervention study. Settting: Jyväskylä Central Hospital, Finland. PARTICIPANTS:243 independently living patients aged 65 years or older admitted to hospital with ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.321.7269.1107

    authors: Huusko TM,Karppi P,Avikainen V,Kautiainen H,Sulkava R

    更新日期:2000-11-04 00:00:00

  • Self help smoking cessation in pregnancy: cluster randomised controlled trial.

    abstract:OBJECTIVES:To evaluate the effectiveness of a self help approach to smoking cessation in pregnancy. DESIGN:Pragmatic cluster randomised controlled trial with community midwife as the unit of randomisation. SETTING:Three NHS hospital trusts in England. PARTICIPANTS:1527 women who smoked at the start of pregnancy. IN...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.325.7377.1383

    authors: Moore L,Campbell R,Whelan A,Mills N,Lupton P,Misselbrook E,Frohlich J

    更新日期:2002-12-14 00:00:00

  • Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study.

    abstract:OBJECTIVE:To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections. DESIGN:Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark. SETTING:Obstetric department and neonatal department...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.39405.539282.BE

    authors: Hansen AK,Wisborg K,Uldbjerg N,Henriksen TB

    更新日期:2008-01-12 00:00:00

  • Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials.

    abstract:OBJECTIVE:To define the benefit of rice oral rehydration salts solution in relation to the glucose based World Health Organisation oral rehydration salts solution for treating and preventing dehydration in patients with severe dehydrating diarrhoea. DESIGN:Meta-analysis using data from 13 available randomised trials t...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章,meta分析

    doi:10.1136/bmj.304.6822.287

    authors: Gore SM,Fontaine O,Pierce NF

    更新日期:1992-02-01 00:00:00

  • Sexual lifestyle of long distance lorry drivers in India: questionnaire survey.

    abstract::This article presents a study on the sexual lifestyle of long distance lorry drivers in India. Using a questionnaire survey method, a total of 5709 consecutive long distance lorry drivers were interviewed by three trained investigators between March 1994 and August 1994. Results showed that 87% (4949 men) of subject...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.318.7177.162

    authors: Rao KS,Pilli RD,Rao AS,Chalam PS

    更新日期:1999-01-16 00:00:00

  • A study of general practitioners' reasons for changing their prescribing behaviour.

    abstract:OBJECTIVES:To explore general practitioners' reasons for recent changes in their prescribing behaviour. DESIGN:Qualitative analysis of semistructured interviews. SETTING:General practice in south east London. SUBJECTS:A heterogeneous sample of 18 general practitioners. RESULTS:Interviewees were able to identify bet...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.312.7036.949

    authors: Armstrong D,Reyburn H,Jones R

    更新日期:1996-04-13 00:00:00

  • Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care.

    abstract:OBJECTIVE:To evaluate the cost effectiveness of acupuncture in the management of chronic headache. DESIGN:Cost effectiveness analysis of a randomised controlled trial. SETTING:General practices in England and Wales. PARTICIPANTS:401 patients with chronic headache, predominantly migraine. Interventions Patients were ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38033.896505.EB

    authors: Wonderling D,Vickers AJ,Grieve R,McCarney R

    更新日期:2004-03-27 00:00:00

  • The social origins of infantile colic: questionnaire study covering 76,747 infants.

    abstract:OBJECTIVE:To describe risk factors for infantile colic. DESIGN:Questionnaire administered by health visitors. SETTING:Sheffield. SUBJECTS:Mothers of 76,747 infants born between 1 August 1975 and 31 May 1988, interviewed when the infant was 1 month old. MAIN OUTCOME MEASURES:Reporting of infantile colic and its dura...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.314.7090.1325

    authors: Crowcroft NS,Strachan DP

    更新日期:1997-05-03 00:00:00

  • Effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy to treat patients with depression: randomised controlled trial.

    abstract:OBJECTIVE:To assess the effectiveness of teaching general practitioners skills in brief cognitive behaviour therapy. DESIGN:Parallel group, cluster randomised, controlled trial of an educational package on cognitive behaviour therapy. SETTING:General practices in north London. PARTICIPANTS:84 general practitioner pr...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1136/bmj.324.7343.947

    authors: King M,Davidson O,Taylor F,Haines A,Sharp D,Turner R

    更新日期:2002-04-20 00:00:00

  • Rates for obstetric intervention among private and public patients in Australia: population based descriptive study.

    abstract:OBJECTIVE:To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among women at low risk in these groups. DESIGN:Population based descriptive study. SETTING:New South Wales, Australia. SUBJECTS:All 171,157 women having a live baby during 19...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.321.7254.137

    authors: Roberts CL,Tracy S,Peat B

    更新日期:2000-07-15 00:00:00

  • Risk factors for HIV infection in people attending clinics for sexually transmitted diseases in India.

    abstract:OBJECTIVE:To investigate the risk factors for HIV infection in patients attending clinics for sexually transmitted diseases in India. DESIGN:Descriptive study of HIV serology, risk behaviour, and findings on physical examination. SUBJECTS:2800 patients presenting to outpatient clinics between 13 May 1993 and 15 July ...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.311.7000.283

    authors: Rodrigues JJ,Mehendale SM,Shepherd ME,Divekar AD,Gangakhedkar RR,Quinn TC,Paranjape RS,Risbud AR,Brookmeyer RS,Gadkari DA

    更新日期:1995-07-29 00:00:00

  • Household based treatment of drinking water with flocculant-disinfectant for preventing diarrhoea in areas with turbid source water in rural western Kenya: cluster randomised controlled trial.

    abstract:OBJECTIVE:To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa. DESIGN:Cluster randomised controlled trial over 20 weeks. SETTING:Family compou...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1136/bmj.38512.618681.E0

    authors: Crump JA,Otieno PO,Slutsker L,Keswick BH,Rosen DH,Hoekstra RM,Vulule JM,Luby SP

    更新日期:2005-09-03 00:00:00

  • Risk behaviours for HIV infection among injecting drug users attending a drug dependency clinic.

    abstract::To study a range of possible risk factors for HIV among injecting drug user patients attending a clinic in London were interviewed from November 1986 to November 1987. Serum samples were tested for viral markers. Of 116 patients, 101 had shared injecting equipment, 75 on the first occasion of injecting and 76 during t...

    journal_title:BMJ (Clinical research ed.)

    pub_type: 杂志文章

    doi:10.1136/bmj.298.6680.1081

    authors: Hart GJ,Sonnex C,Petherick A,Johnson AM,Feinmann C,Adler MW

    更新日期:1989-04-22 00:00:00