To the Editor Weintraub et al1 recently published an article in JAMA Neurology on the mortality risk associated with antipsychotic use in Parkinson disease (PD). We do not deny that the collective evidence has strongly suggested that neuroleptics are associated with increased mortality in elderly populations and in the setting of dementia.2,3 The Weintraub et al1 investigation addressed mortality associated with neuroleptic use in PD. The authors did the best they could with the available large data set; however, there was an important limitation. There was no clear comparator group of patients with PD and active psychosis who were not treated with neuroleptics. Additionally, very few patients in the sample were treated with the preferred drug clozapine, which does not worsen parkinsonism.
Malaty IA, Okun MS, Jaffee M. The Danger of Not Treating Parkinson Disease Psychosis. JAMA Neurol. 2016;73(9):1156. doi:10.1001/jamaneurol.2016.2280