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. 2023 Jun 25;12(13):4263.
doi: 10.3390/jcm12134263.

Antipsychotic Use and Mortality in Persons with Alcohol-Related Dementia or Wernicke-Korsakoff Syndrome: A Nationwide Register Study in Finland

Anniina Palm  1   2 , Tiina Talaslahti  1   2 , Risto Vataja  1   2 , Milena Ginters  1   2 , Hannu Kautiainen  3   4 , Henrik Elonheimo  5 , Jaana Suvisaari  5 , Nina Lindberg  1   2 , Hannu Koponen  1   2
Affiliations

Antipsychotic Use and Mortality in Persons with Alcohol-Related Dementia or Wernicke-Korsakoff Syndrome: A Nationwide Register Study in Finland

Anniina Palm et al. J Clin Med. .

Abstract

Background: Research on the use of psychotropic drugs in people with alcohol-related neurocognitive disorders is virtually nonexistent. We examined the prevalence of antipsychotic drug use and its effect on mortality among patients with Wernicke-Korsakoff syndrome (WKS) or alcohol-related dementia (ARD).

Methods: In this nationwide register study, we collected data on the medication use and mortality of all persons aged ≥40 diagnosed with WKS (n = 1149) or ARD (n = 2432) between 1998 and 2015 in Finland. We calculated the prevalence of antipsychotic use within one year of diagnosis and the adjusted cumulative mortality of antipsychotic users versus non-users in relation to the age-, sex-, and calendar year-matched general population.

Results: Of the WKS and ARD patients, 35.9% and 38.5%, respectively, purchased one or more antipsychotic drugs in the year following diagnosis. The adjusted cumulative mortality of the antipsychotic users was significantly lower than that of non-users in both the WKS and ARD groups, where the adjusted hazard ratios (95% CI) were 0.85 (0.72-0.99) and 0.73 (0.65-0.81), respectively. WKS and ARD patients using antipsychotics were less likely to die of alcohol-related causes than antipsychotic non-users, but the difference was significant only in the ARD group.

Conclusions: This population-based study shows that antipsychotic use is common in patients with WKS or ARD. In contrast to other dementia studies, our results indicate that the mortality of antipsychotic users is significantly lower than that of non-users. The lower mortality could be explained by decreased alcohol use and better healthcare coverage in antipsychotic users.

Keywords: Wernicke–Korsakoff syndrome; alcohol-related dementia; antipsychotics; mortality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Antipsychotic purchases within one year of diagnosis. Hommel’s multiple comparison procedure was used to correct significance levels for post hoc testing; ** p < 0.01, *** p < 0.001. ARD: alcohol-related dementia; WKS: Wernicke–Korsakoff syndrome.
Figure 2
Figure 2
Age- and sex-adjusted cumulative mortality in WKS and ARD patients. ARD: alcohol-related dementia; HR: hazard ratio; WKS: Wernicke–Korsakoff syndrome.
Figure 3
Figure 3
Age- and sex-adjusted cumulative mortality due to alcohol-related causes in WKS and ARD patients. We calculated the cumulative mortality in the presence of competing events, where the rest of the causes of death were considered as competing risks. ARD: alcohol-related dementia; sHR: subhazard ratio; WKS: Wernicke–Korsakoff syndrome.
Figure 4
Figure 4
Age- and sex-adjusted subhazard ratio (sHR) of WKS and ARD patients using antipsychotics compared with antipsychotic non-users, stratified by causes of death (ICD-10 diagnosis groups). The value for antipsychotic non-users is represented by the dotted line, i.e., 1. For calculating sHRs, we used the competing risks regression model, where the rest of the causes of death were considered as competing risks. ARD: alcohol-related dementia; sHR: subhazard ratio; WKS: Wernicke–Korsakoff syndrome.
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