From the Guidelines
There is no clear evidence that Seroquel (quetiapine) directly causes dementia, but it may increase the risk of death and cerebrovascular events in elderly patients with dementia-related psychosis, as warned by the FDA 1. Seroquel is an atypical antipsychotic medication commonly prescribed for conditions like schizophrenia, bipolar disorder, and sometimes as an off-label treatment for insomnia or anxiety. The most recent evidence suggests that antipsychotic medications, including Seroquel, should be used with caution in patients with dementia, as they may increase the risk of adverse effects, including falls, stroke, and death 1. Some studies suggest that long-term use of antipsychotics might be associated with cognitive decline, but a direct causal relationship between Seroquel and developing dementia has not been established 1. The medication works by affecting neurotransmitters in the brain, particularly dopamine and serotonin, which can cause sedation and other side effects that might temporarily mimic cognitive impairment. If you're concerned about cognitive effects while taking Seroquel, it's essential to discuss these concerns with your healthcare provider rather than stopping the medication abruptly, as sudden discontinuation can lead to withdrawal symptoms. High-quality, person-centered care, including psychosocial interventions, is now recognized as the first line of prevention and treatment for behavioral and psychological symptoms of dementia (BPSD), with medication used as a carefully monitored, short-term, last resort in specific cases 1.
Key points to consider:
- Seroquel may increase the risk of death and cerebrovascular events in elderly patients with dementia-related psychosis
- Antipsychotic medications, including Seroquel, should be used with caution in patients with dementia
- Long-term use of antipsychotics might be associated with cognitive decline, but a direct causal relationship between Seroquel and developing dementia has not been established
- Person-centered care and psychosocial interventions are the first line of treatment for BPSD, with medication used as a last resort.
From the Research
Seroquel and Dementia
- Seroquel, also known as quetiapine, is an antipsychotic medication that can have significant side effects in older adults, including cognitive decline and dementia 2.
- A systematic literature review found that quetiapine use in older adults is associated with adverse events such as somnolence, dizziness, headache, postural hypotension, and weight gain 3.
- Compared to other antipsychotics, quetiapine had a lower risk of mortality and cerebrovascular events, but a higher risk of falls and injury, and metabolic disorders 3.
- A case report found that quetiapine improved cognitive function in a patient with dementia with Lewy bodies, suggesting that the medication may have different effects in different types of dementia 4.
- Anticholinergic medications, which include some antipsychotics like quetiapine, have been shown to increase the risk of dementia in older adults, particularly with long-term use and high cumulative doses 5.
Mechanisms of Cognitive Decline
- Cognitive decline in aging is associated with changes in the central nervous system, including cortical thickness, cerebral white matter structure and function, and blood-brain barrier disruption 6.
- Peripheral factors, such as insulin resistance, inflammation, and vascular dysfunction, can also contribute to cognitive deterioration 6.
- High-intensity interval training (HIIT) may be a promising strategy to counteract changes that accompany the aging process and improve cognitive health 6.