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67/100

✓ Peer-reviewed alzhub usefulness score 67 out of 100. Clinical safety

Topic: Drug trials: efficacy and safety

Plain-language summary

In covariate-adjusted intent-to-treat analyses, haloperidol was associated with the highest mortality rates (relative risk=1.54, 95% confidence interval [CI]=1.38-1.73) followed by risperidone (reference), olanzapine (relative risk=0.99, 95% CI=0.89-1.10), valproic acid and its derivatives (relative risk=0.91, 95% CI=0.78-1.06), and quetiapine (relative risk=0.73, 95% CI=0.67-0.80). Propensity-stratified and propensity-weighted models as well as analyses controlling for site of care and medication dosage revealed similar patterns. The mortality risk with haloperidol was highest in the first 30 days but decreased significantly and sharply thereafter. Among the other agents, mortality risk differences were most significant in the first 120 days and declined in the subsequent 60 days during follow-up. There may be differences in mortality risks among individual antipsychotic agents used for treating patients with dementia. The use of valproic acid and its derivatives as alternative agents to address the neuropsychiatric symptoms of dementia may carry associated risks as well.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

Kales, H. C., Kim, H. M., Zivin, K., Valenstein, M. M., Seyfried, L. S., Chiang, C., et al. (2011). Risk of Mortality Among Individual Antipsychotics in Patients With Dementia. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2011.11030347

Vancouver

Kales HC, Kim HM, Zivin K, Valenstein MM, Seyfried LS, Chiang C, et al. Risk of Mortality Among Individual Antipsychotics in Patients With Dementia. American Journal of Psychiatry. 2011. doi:10.1176/appi.ajp.2011.11030347. PMID: 22193526.

BibTeX

@article{kales2011-22193526,
  author  = {Kales, Helen C. and Kim, Hyungjin Myra and Zivin, Kara and Valenstein, Marcia M. and Seyfried, Lisa S. and Chiang, Claire and Cunningham, Francesca E. and Schneider, Lon S. S. and others},
  title   = {{Risk of Mortality Among Individual Antipsychotics in Patients With Dementia}},
  journal = {American Journal of Psychiatry},
  year    = {2011},
  doi     = {10.1176/appi.ajp.2011.11030347},
  pmid    = {22193526},
  url     = {https://doi.org/10.1176/appi.ajp.2011.11030347}
}

Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.

How to read this study

Design: this is a follow-up (cohort) study. People are observed over time and not assigned to anything, so an association can reflect other differences between groups. Look at how long follow-up lasted, how many dropped out, and whether the authors adjusted for age, education and other health conditions.
Size: the record lists 33,604 participants. Ask whether that is enough for the question, and who they were.
Effect: the record gives no effect size, so the summary above cannot say how large any difference was.

What the evidence grade means here

This page is graded moderate. alzhub.org assigns the grade automatically from keywords in the abstract, not from reading the paper. Moderate means the abstract mentions a cohort, case-control or longitudinal design. It can add at most 5 of the 100 points in the study score, and it is a label about design, not a verdict on whether the findings are true.

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Key findings

In covariate-adjusted intent-to-treat analyses, haloperidol was associated with the highest mortality rates (relative risk=1.54, 95% confidence interval [CI]=1.38-1.73) followed by risperidone (reference), olanzapine (relative risk=0.99, 95% CI=0.89-1.10), valproic acid and its derivatives (relative risk=0.91, 95% CI=0.78-1.06), and quetiapine (relative risk=0.73, 95% CI=0.67-0.80).
Propensity-stratified and propensity-weighted models as well as analyses controlling for site of care and medication dosage revealed similar patterns.
The mortality risk with haloperidol was highest in the first 30 days but decreased significantly and sharply thereafter.
Among the other agents, mortality risk differences were most significant in the first 120 days and declined in the subsequent 60 days during follow-up.
There may be differences in mortality risks among individual antipsychotic agents used for treating patients with dementia.

Study details

Study designcohort study
Participants33,604
Evidence strengthModerate

How this study scored 67/100

Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 39 of the 58 points we could judge it on, which is 67 out of 100.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (American Journal of Psychiatry)
Journal's citation record	— / 4	No journal record from OpenAlex — left out of this score
Study design	7 / 12	A cohort study following people over time
Strength of evidence	3 / 5	Rated “moderate” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	1 / 5	2011 — within 20 year(s) of the newest study here
Sample size	4 / 4	33,604 participants
Effect reported	0 / 3	No effect size reported — scores zero (not stated in the record — scored 0)
Studied in people	3 / 3	Studied in people (participant count stated)
Randomized / blinded	0 / 2	No randomization or blinding stated — scores zero (not stated in the record — scored 0)
Times cited	— / 7	No citation count (not found in OpenAlex) — left out of this score
Citations per year	— / 5	No citation count or no year — left out of this score
Impact for its field and year	— / 6	No field-weighted citation impact (OpenAlex has none yet) — left out of this score
Cited by studies here	— / 6	Not yet checked against this library's citation graph — left out of this score
Still being cited	— / 4	No yearly citation counts — left out of this score
Senior author's track record	— / 4	Senior author's record not available — left out of this score
Institution's track record	— / 3	No institution listed in OpenAlex — left out of this score
Multicenter collaboration	— / 3	Institutions not listed — left out of this score
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 22193526)
Free to read	2 / 2	Free to read
Points	39 / 58	Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 39 of the 58 points we could judge it on is 67 out of 100.
Total	67 / 100	—

What each of these 20 components measures, and what this score is not →

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