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François M, Sicsic J, Pelletier-Fleury N. Determinants of antidementia drug prescription in patients older than 65: A latent class analysis. Pharmacoepidemiol Drug Saf 2020; 29:444-452. [PMID: 32067291 DOI: 10.1002/pds.4921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Antidementia drugs (cholinesterase inhibitors and memantine) are still widely prescribed despite their controversial effects and 2011 guidelines that no longer encourage their prescription. The objective was to assess which factors remained determinants of antidementia drug prescriptions. METHODS A cross-sectional study was performed in 2013. Patients suffering from dementia, aged 65 and over, identified in the French national health insurance database were included. Because we anticipated a high correlation between age, comorbidities, and health care use, we first identified the patients' health status by a latent class analysis. Second, we performed adjusted logistic regression models. The explanatory variables were patients' health status, gender, prescription of nonpharmacological treatments (physical and speech therapies), prescription of psychotropic drugs, and access to health care. RESULTS Among the 3873 patients included, 38% received antidementia drugs. Three latent classes of patients with different health status were identified. Patients with poor health status received significantly fewer antidementia drugs (P < .001). Patients with speech therapy or antidepressant drugs received significantly more antidementia drugs (P < .001), whereas patients with physical therapy received significantly fewer antidementia drugs (P = .006). CONCLUSION Antidementia drugs were less likely to be prescribed for patients with poor health status. This result is encouraging for these frail patients who are more vulnerable to the adverse effects of treatments. At the same time, this result encourage targeting specifically patients in good health status for the use of a decision aid, in an attempt to limit prescriptions by involving patients and families.
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Affiliation(s)
- Mathilde François
- INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, UMR1018, hôpital Paul Brousse, Université Paris Saclay, Villejuif Cedex, France.,Département de médecine générale, Faculté des sciences de la santé Simone Veil, Université Versailles-Saint-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Jonathan Sicsic
- INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, UMR1018, hôpital Paul Brousse, Université Paris Saclay, Villejuif Cedex, France
| | - Nathalie Pelletier-Fleury
- INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, UMR1018, hôpital Paul Brousse, Université Paris Saclay, Villejuif Cedex, France
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van Weel JM, Renehan E, Ervin KE, Enticott J. Home care service utilisation by people with dementia-A retrospective cohort study of community nursing data in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:665-675. [PMID: 30421836 DOI: 10.1111/hsc.12683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 09/15/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
Progressive aged care reforms are shifting dementia care into the community. These efforts have been shown to prevent transition to residential aged care facilities and hospitals. There is a paucity of studies examining the utilisation of home care services for people living with dementia. This study aims to address the current knowledge gap by providing a comprehensive summary of older adults receiving home care and comparing service use for people with and without dementia. A retrospective secondary data analysis was conducted using routine data prospectively collected from a cohort (n = 2,703 with dementia matched to 9,224 without dementia; total 11,927) using a community home nursing service in metropolitan Melbourne, Australia, in 2014. Descriptive statistics compared individuals with and without dementia on client-level demographics and their episode of home care service use. A comparative analysis on select variables was also performed using a conditional Poisson regression to estimate relative risk (RR). Compared to older adults without dementia, people with dementia were more likely to be born overseas (RR 1.10, 95% CI [1.03-1.19]), require an interpreter (RR 1.41, 95% CI [1.26-1.59]), and live with family (RR 1.09 [1.01-1.16]). When examining an individual's episode of care, people with dementia were more likely to require acute care (RR 1.07, 95% CI [1.01-1.14]) and be discharged from home care with personal care services (RR 1.46, 95% CI [1.24-1.72]). People with dementia were less likely to be referred from a hospital (RR 0.73, 95% CI [0.69-0.77]), achieve their home care goals (RR 0.91, 95% CI [0.87-0.94]), or die while in receipt of home care services (RR 0.82, 95% CI [0.72-0.94]). Our findings suggest that people with dementia have different socio-demographic characteristics and interactions with home care services compared to people without dementia.
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Affiliation(s)
- Joel M van Weel
- Peninsula Health, Department of Medicine, Frankston, VIC, Australia
| | - Emma Renehan
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
| | - Kaye E Ervin
- Department of Rural Health, The University of Melbourne, Shepparton, VIC, Australia
| | - Joanne Enticott
- Bolton Clarke Research Institute, Melbourne, VIC, Australia
- Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Maclagan LC, Bronskill SE, Guan J, Campitelli MA, Herrmann N, Lapane KL, Hogan DB, Amuah JE, Seitz DP, Gill SS, Maxwell CJ. Predictors of Cholinesterase Discontinuation during the First Year after Nursing Home Admission. J Am Med Dir Assoc 2018; 19:959-966.e4. [PMID: 30262440 DOI: 10.1016/j.jamda.2018.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/24/2018] [Accepted: 07/28/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES For persons with dementia, the appropriate duration of cholinesterase inhibitor (ChEI) use remains unclear. We examined patterns of ChEI use during nursing home (NH) transition and the factors associated with discontinuation following admission. DESIGN Population-based retrospective cohort study using linked health administrative and Resident Assessment Instrument Minimum Dataset, version 2.0 databases. SETTING AND PARTICIPANTS A total of 47,851 older adults (mean age = 84.8 years, standard deviation = 6.8) with dementia newly admitted to a NH in Ontario, Canada between 2011 and 2015. MEASUREMENTS ChEI use at admission and during the following year was identified from prescription claims. Resident sociodemographic and health characteristics at admission, including a 72-item frailty index, were derived from the Resident Assessment Instrument Minimum Dataset 2.0. Additional resident and prescriber characteristics were derived from administrative data. Discontinuation was defined as a 30+-day gap in ChEI supply. Multivariable subdistribution hazard models were used to estimate the independent effect of resident frailty and other factors on ChEI discontinuation. RESULTS Approximately one-third (17,560) of residents with dementia were on a ChEI at admission. Among this group, 17.7% (3110) discontinued use over follow-up. Incidence of discontinuation was significantly higher among residents with syncope [subdistribution hazard ratio, sHR = 2.21, 95% confidence interval, CI (1.52, 3.22)], more severe behavioral symptoms [sHR = 1.79, 95% CI (1.57, 2.05)], cognitive impairment [sHR = 1.26, 95% CI (1.07, 1.48)], higher frailty, [sHR = 1.19, 95% CI (1.04, 1.36)], and a primary prescriber active in the NH [sHR = 1.28, 95% CI (1.14, 1.45)]. A significantly lower incidence was observed for older and unmarried residents and those with a longer duration of use. CONCLUSIONS/IMPLICATIONS Less than one-fifth of residents on a ChEI at admission discontinued use during the following year. Although some of the predictors of discontinuation align with past research and current clinical recommendations, others were unexpected and point to novel drivers of ChEI use. Future investigations should explore the varied reasons underlying these associations and resident outcomes associated with ChEI discontinuation.
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Affiliation(s)
- Laura C Maclagan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Nathan Herrmann
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joseph E Amuah
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dallas P Seitz
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada; Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada; Providence Care Hospital, Kingston, Ontario, Canada
| | - Colleen J Maxwell
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
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Chen P, Guarino PD, Dysken MW, Pallaki M, Asthana S, Llorente MD, Love S, Vertrees JE, Schellenberg GD, Sano M. Neuropsychiatric Symptoms and Caregiver Burden in Individuals With Alzheimer's Disease: The TEAM-AD VA Cooperative Study. J Geriatr Psychiatry Neurol 2018; 31:177-185. [PMID: 29966477 DOI: 10.1177/0891988718783897] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the prevalence of neuropsychiatric symptoms (NPS) in mild-to-moderate Alzheimer disease (AD) and their association with caregiver burden. METHODS Secondary analyses of baseline data from the Trial of Vitamin E and Memantine in Alzheimer's Disease (TEAM-AD) (N=613). Neuropsychiatric Inventory were used to measure severity of NPS and caregiver activity survey to measure caregiver burden. RESULTS A total of 87% of patients displayed at least 1 NPS; 70% displayed clinically meaningful NPS. The most common symptoms were apathy (47%), irritability (44%), agitation (42%), and depression (40%). Those with moderate AD had more severe NPS than those with mild AD ( P = .03). Neuropsychiatric symptoms were significantly associated with caregiver time after adjusting for age, education, cognitive function, and comorbidity ( P-value < .0001) with every point increase in NPS associated with a 10-minute increase in caregiver time. CONCLUSION Neuropsychiatric symptoms were prevalent in both mild and moderate AD, even in patients receiving treatment with an acetylcholinesterase inhibitors, and were more severe in moderate AD and associated with greater caregiver time.
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Affiliation(s)
- Peijun Chen
- 1 Department of Psychiatry, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 2 Department of Psychiatry, Geriatric Psychiatry Division, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peter D Guarino
- 3 Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- 4 Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Maurice W Dysken
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Muralidhar Pallaki
- 7 Department of Medicine, VISN 10 GRECC, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- 8 Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sanjay Asthana
- 9 William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- 10 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maria D Llorente
- 11 Washington DC VA Medical Center, Washington, DC, USA
- 12 Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Susan Love
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
- 6 Department of Psychiatry, Minneapolis, University of Minnesota School of Medicine, MN, USA
| | - Julia E Vertrees
- 13 VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Gerard D Schellenberg
- 14 Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Mary Sano
- 15 Bronx Veterans Medical Research Center, New York, NY, USA
- 16 Alzheimer's Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Tsujimura T, Sakai S, Suzuki T, Ujihara I, Tsuji K, Magara J, Canning BJ, Inoue M. Central inhibition of initiation of swallowing by systemic administration of diazepam and baclofen in anaesthetized rats. Am J Physiol Gastrointest Liver Physiol 2017; 312:G498-G507. [PMID: 28254772 PMCID: PMC6347068 DOI: 10.1152/ajpgi.00299.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 02/15/2017] [Accepted: 02/26/2017] [Indexed: 01/31/2023]
Abstract
Dysphagia is caused not only by neurological and/or structural damage but also by medication. We hypothesized memantine, dextromethorphan, diazepam, and baclofen, all commonly used drugs with central sites of action, may regulate swallowing function. Swallows were evoked by upper airway (UA)/pharyngeal distension, punctate mechanical stimulation using a von Frey filament, capsaicin or distilled water (DW) applied topically to the vocal folds, and electrical stimulation of a superior laryngeal nerve (SLN) in anesthetized rats and were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles and by visualizing laryngeal elevation. The effects of intraperitoneal or topical administration of each drug on swallowing function were studied. Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABAA receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABAB receptor antagonist diminished the effects of baclofen. Topically applied diazepam or baclofen had no effect on swallowing. These data indicate that diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.NEW & NOTEWORTHY Systemic administration of diazepam and baclofen, but not memantine or dextromethorphan, inhibited swallowing evoked by mechanical, chemical, and electrical stimulation. Both benzodiazepines and GABAA receptor antagonists diminished the inhibitory effects of diazepam, whereas a GABAB receptor antagonist diminished the effects of baclofen. Topical applied diazepam or baclofen was without effect on swallowing. Diazepam and baclofen act centrally to inhibit swallowing in anesthetized rats.
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Affiliation(s)
- Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Shogo Sakai
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Taku Suzuki
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Izumi Ujihara
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Kojun Tsuji
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | - Jin Magara
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
| | | | - Makoto Inoue
- 1Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; and
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Kirkham J, Sherman C, Velkers C, Maxwell C, Gill S, Rochon P, Seitz D. Antipsychotic Use in Dementia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:170-181. [PMID: 28212496 PMCID: PMC5317021 DOI: 10.1177/0706743716673321] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Antipsychotics are necessary for many older adults to treat major mental illnesses or reduce distressing psychiatric symptoms. Current controversy exists over the role of antipsychotics in the management of neuropsychiatric symptoms (NPS) in persons with dementia. Although some NPS may be appropriately and safely treated with antipsychotics, a fine balance must be achieved between the benefits of these medications, which are often modest, and adverse events, which may have significant consequences. Approximately one-third of all persons with dementia are currently prescribed antipsychotic medications, and there is significant variation in the use of antipsychotics across care settings and providers. Reducing the inappropriate or unnecessary use of antipsychotics among persons with dementia has been the focus of increasing attention owing to better awareness of the potential problems associated with these medications. Several approaches can be used to curb the use of antipsychotics among persons with dementia, including policy or regulatory changes, public reporting, and educational outreach. Recently, there has been encouraging evidence of a downward trend in the use of antipsychotics in many long-term care settings, although prescribing rates are still higher than what is likely optimal. Although reducing the inappropriate use of antipsychotics is a complex task, psychiatrists can play an important role via the provision of clinical care and research evidence, contributing to improved care of persons with dementia in Canada and elsewhere.
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Affiliation(s)
- Julia Kirkham
- Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Chelsea Sherman
- Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Clive Velkers
- Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Colleen Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario
| | - Sudeep Gill
- Division of Geriatric Medicine, Department of Medicine, Queen’s University, Kingston, Ontario
| | - Paula Rochon
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario
| | - Dallas Seitz
- Department of Psychiatry, Queen’s University, Kingston, Ontario
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Farré M, Haro JM, Kostov B, Alvira C, Risco E, Miguel S, Cabrera E, Zabalegui A. Direct and indirect costs and resource use in dementia care: A cross-sectional study in patients living at home. Int J Nurs Stud 2016; 55:39-49. [DOI: 10.1016/j.ijnurstu.2015.10.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
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Törmälehto SM, Martikainen JA, Väätäinen ST, Hallikainen IT, Hallikainen M, Bell JS, Koivisto AM. Use of Anti-Dementia Drugs in Relation to Change in Cognition, Behavior, and Functioning in Alzheimer’s Disease over a Three-Year Period: Kuopio ALSOVA Study. J Alzheimers Dis 2015; 48:1033-41. [DOI: 10.3233/jad-150092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Soili M. Törmälehto
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Janne A. Martikainen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Saku T. Väätäinen
- Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Ilona T. Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
- School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland
| | - Merja Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - J. Simon Bell
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Anne M. Koivisto
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
- Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland
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Fereshtehnejad SM, Johnell K, Eriksdotter M. Anti-dementia drugs and co-medication among patients with Alzheimer's disease : investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem). Drugs Aging 2014; 31:215-24. [PMID: 24497071 DOI: 10.1007/s40266-014-0154-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is a substantial risk of drug-interactions, adverse events, and inappropriate drug use (IDU) among frail Alzheimer's disease (AD) patients; however, there are few studies about co-medication and IDU in clinical settings. OBJECTIVES To investigate anti-dementia drugs, associated characteristics of cholinesterase inhibitors (ChEIs) and NMDA antagonists, co-medication, and IDU in a large population of outpatients with mild AD. METHODS In this cross-sectional analysis of medication characteristics, we analyzed data from the Swedish Dementia Quality Registry (SveDem) on 5,907 newly diagnosed AD patients who were registered in memory clinics. SveDem is a national quality registry in Sweden, which was established in 2007 to evaluate and improve dementia healthcare. Comparisons were performed concerning co-medications, use of ≥3 psychotropic drugs (IDU) and polypharmacy (≥5 drugs) based on anti-dementia treatment (ChEIs or NMDA antagonists). Information on baseline characteristics such as age, sex, living conditions, cognitive evaluation based on the Mini-Mental State Examination (MMSE) score, and diagnostic work-up was also evaluated. RESULTS The majority of the AD patients were in the mild stage of the disease. Overall, 4,342 (75.4 %) patients received any ChEI, 438 (7.6 %) used an NMDA antagonist and 74 (1.3 %) patients were treated with both. However, 907 (15.7 %) patients were not treated with any anti-dementia drug. While polypharmacy was seen in 33.5 % of patients, only 2.6 % concurrently used ≥3 psychotropic medications. Patients on ChEIs were significantly younger, had a higher MMSE score and were treated with a smaller number of medications (a proxy for overall co-morbidity). Co-medication with antipsychotics [3.3 vs. 7.6 %; adjusted odds ratio (OR) 0.55 (95 % CI 0.38-0.79)] and anxiolytics [5.8 vs. 10.9 %; adjusted OR 0.62 (95 % CI 0.46-0.84)] was significantly lower in the ChEI+ group than in those with no anti-dementia treatment. CONCLUSION Patients taking ChEIs were treated with less antipsychotics and anxiolytics than those not taking ChEIs. More research is warranted to elucidate whether use of ChEIs in clinical practice can reduce the need for psychotropic drugs in AD patients.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Novum 5th floor, 14186, Stockholm, Sweden,
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10
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Maxwell CJ, Stock K, Seitz D, Herrmann N. Persistence and adherence with dementia pharmacotherapy: relevance of patient, provider, and system factors. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:624-31. [PMID: 25702361 PMCID: PMC4304581 DOI: 10.1177/070674371405901203] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This paper provides a comprehensive review of studies examining adherence and (or) persistence with dementia pharmacotherapy during the past decade, including a summary of the key patient-, drug-, system-, and provider-level factors associated with these measures. Estimates of adherence and 1-year persistence to these drugs have ranged from 34% to 94% and 35% to 60%, respectively. Though many studies reported nonsignificant associations, there are data suggesting that patient age, sex, ethnoracial background, socioeconomic status, and region-specific reimbursement criteria, as well as the extent and quality of interactions among patients, caregivers, and providers, may influence persistence with pharmacotherapy. As many studies relied on administrative data, limited information was available regarding the relevance of patient's cognitive and functional status or the importance of caregiver involvement or assistive devices to adherence or persistence.
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Affiliation(s)
- Colleen J Maxwell
- Professor, Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario
| | - Kathryn Stock
- Student, School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario
| | - Dallas Seitz
- Assistant Professor, Division of Geriatric Psychiatry, Queen's University and Providence Care, Kingston, Ontario
| | - Nathan Herrmann
- Head, Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario
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Shepherd AJ, Loo L, Mohapatra DP. Chemokine co-receptor CCR5/CXCR4-dependent modulation of Kv2.1 channel confers acute neuroprotection to HIV-1 glycoprotein gp120 exposure. PLoS One 2013; 8:e76698. [PMID: 24086760 PMCID: PMC3782454 DOI: 10.1371/journal.pone.0076698] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022] Open
Abstract
Infection with human immunodeficiency virus-1 (HIV-1) within the brain has long been known to be associated with neurodegeneration and neurocognitive disorder (referred as HAND), a condition characterized in its early stages by declining cognitive function and behavioral disturbances. Mechanistically, the HIV-1 coat glycoprotein 120 (gp120) has been suggested to be a critical factor inducing apoptotic cell death in neurons via the activation of p38 mitogen-activated protein kinase (MAPK), upon chronic exposure to the virus. Here we show that acute exposure of neurons to HIV-1 gp120 elicits a homeostatic response, which provides protection against non-apoptotic cell death, involving the major somatodendritic voltage-gated K+ (Kv) channel Kv2.1 as the key mediator. The Kv2.1 channel has recently been shown to provide homeostatic control of neuronal excitability under conditions of seizures, ischemia and neuromodulation/neuroinflammation. Following acute exposure to gp120, cultured rat hippocampal neurons show rapid dephosphorylation of the Kv2.1 protein, which ultimately leads to changes in specific sub-cellular localization and voltage-dependent channel activation properties of Kv2.1. Such modifications in Kv2.1 are dependent on the activation of the chemokine co-receptors CCR5 and CXCR4, and subsequent activation of the protein phosphatase calcineurin. This leads to the overall suppression of neuronal excitability and provides neurons with a homeostatic protective mechanism. Specific blockade of calcineurin and Kv2.1 channel activity led to significant enhancement of non-apoptotic neuronal death upon acute gp120 treatment. These observations shed new light on the intrinsic homeostatic mechanisms of neuronal resilience during the acute stages of neuro-HIV infections.
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Affiliation(s)
- Andrew J. Shepherd
- Department of Pharmacology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Lipin Loo
- Department of Pharmacology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Durga P. Mohapatra
- Department of Pharmacology, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
- Department of Anesthesia, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
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