Separate placebo-controlled clinical trials in elderly patients with dementia have suggested that the use of olanzapine (Zyprexa®) in patients > 65 years and risperidone (Risperdal®) in patients between 73 – 97 years of age may be associated with an increased incidence of CVAEs including stroke and transient ischaemic attacks and deaths. Recent analyses showed a 3-fold increase in CVAEs for olanzapine (1.3% vs 0.4%) and risperidone (3.4% vs 1.2%) when compared to placebo groups respectively. The majority of patients (>70%) in these studies had Alzheimer's disease and the excess risk of stroke was not confined to patients with a vascular basis for their dementia.

The efficacy of Zyprexa® in this group of patient has not been established and it is not licensed for use in elderly patients with dementia. Physicians are reminded to consider the risks and benefits of the use of these drugs in elderly patients, taking into account risk predictors for stroke in the individual patient. Patients and their caregivers should be counselled to look out for signs and symptoms of potential CVAEs.