In dementia or cognitive impairment, which drug class is listed as inappropriate due to adverse CNS effects and stroke risk with chronic use?

• A. Anticholinergics
• B. Antipsychotics, chronic use
• C. Benzodiazepines
• D. Z-drugs

Answer: (B)

In dementia, the safety profile of antipsychotics is a key concern. Chronic use of antipsychotics is listed as inappropriate because these drugs are linked to an increased risk of cerebrovascular events, including stroke, and to higher mortality in older adults with cognitive impairment. They also cause adverse CNS effects such as sedation, delirium, and extrapyramidal symptoms, which can worsen cognition and functional ability. That combination—stroke risk plus CNS side effects with long-term use—makes this class particularly problematic for dementia patients.

Other options may carry CNS risks (like sedation or confusion) but don’t have the same well-documented link to stroke with chronic use, so they aren’t singled out for stroke risk in the Beers criteria. If an antipsychotic is ever considered, it should be used only if absolutely necessary, at the lowest effective dose for the shortest possible duration, with careful monitoring and a strong emphasis on nonpharmacologic management first.