AAP: Linda A. Johnson, Associated Press Writer

Widely prescribed anti-psychotic drugs do not help most Alzheimer‘s patients with delusions and aggression and are not worth the risk of sudden death and other side effects, the first major study on sufferers outside nursing homes concludes.

"These medications are not the answer," said Dr. Thomas Insel, director of the National Institute of Mental Health, which paid for the study. He said better medications are at least several years away.

Three-fourths of the 4.5 million Americans with Alzheimer‘s disease Alzheimer‘s disease develop aggression, hallucinations or delusions, which can lead them to lash out at caregivers or harm themselves. This behavior is the most common reason families put people with Alzheimer‘s in a nursing home.

Yet roughly one-quarter of nursing home patients are on these drugs, and at least that many patients at home have used them, mainly because there are no great alternatives and there was some evidence they might help a little, experts say.

The study tested the drugs on 421 patients at 42 medical centers who needed considerable care but were living in their own home, a relative‘s or an assisted-living facility. The findings were reported in Thursday‘s New England Journal of Medicine .

About four in five patients stopped taking their pills early — on average, within five to eight weeks — because the medications were ineffective or had side effects that included grogginess, worsening confusion, weight gain, and Parkinson‘s-like symptoms such as rigidity and trouble walking.

Symptoms did improve in about 30 percent of patients taking the drugs, as well as in 21 percent of those getting dummy pills, partly because symptoms can naturally wax and wane.

While the federal government paid for the study, the medications were supplied by the manufacturers: AstraZeneca Pharmaceuticals LP, maker of Seroquel; Eli Lilly and Co., maker of Zyprexa; and Johnson & Johnson, maker of Risperdal. Most of the researchers have received grants or consulting or lecture fees from the industry.

Lead researcher Dr. Lon Schneider, director of the Alzheimer‘s Disease Center of California and a University of Southern California professor, said doctors should try the drugs if necessary, but watch patients closely and switch to something else after a few weeks if there is no improvement or side effects are too severe.

Schneider said nursing home residents need the drugs more because their behavior problems are generally worse than patients still at home, but their health is more fragile, raising the danger of side effects.

Also, possible causes such as dehydration, infections and side effects from other medications should be ruled out.

Kawas noted that with the U.S. population aging, the number of Alzheimer‘s patients is expected to quadruple by mid-century to about 18 million.

On the Net: http://www.nejm.org

Alzheimer‘s Association: http://www.alz.org