The study by Rochon et al1 on antipsychotic therapy for older adults provides an important review that is of common concern. With recognition of the study's commendable efforts, there is an additional perspective that might be considered, specifically, that treatment indication could be examined, beyond just comparing patients with a similar diagnosis.
Their control group of adults with dementia may have had recent physician contact, but these patients may not have met the threshold of a clinician's judgment that behavioral agitation or psychotic findings warranted antipsychotic treatment. While patients with tics, parkinsonism, or brain tumor disorders were appropriately excluded in evaluating outcomes, those included likely still comprised a notable number of patients with agitated dementia, who may have been selectively biased into the treatment subgroups. A different control group focused on treatment indication, instead of comparing with other patients with dementia, might have proved more informative.
Kassabian S. Antipsychotic Therapy for Dementia in Elderly Patients. Arch Intern Med. 2009;169(1):87-89. doi:10.1001/archinternmed.2008.553