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Rodríguez Espinosa N, Gonzalez-Colaço Harmand M, Moro Miguel MA. [Use of antipsychotics in patients with dementia in Spain: Comparison with prescription of acetylcholinesterase inhibitors and memantine and analysis of associations]. Rev Esp Geriatr Gerontol 2024; 59:101446. [PMID: 38029634 DOI: 10.1016/j.regg.2023.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE We have analyzed the prevalence of antipsychotics in patients with dementia in Spain, their age distribution and the influence of treatment with IACEs and memantine on their prescription. METHOD Descriptive, retrospective and cross-sectional study of the 2017 BIFAP database in over 65 years of age with dementia. Prescriptions of antipsychotics, IACEs and memantine were collected. For antipsychotics were also collected, the duration of treatment and time from dementia diagnosis to prescription. RESULTS A total of 1,327,792 subjects were retrieved, 89,464 (6.73%) with dementia. Antipsychotics were prescribed in 31.76%; by frequency: quetiapine (58.47%), risperidone (21%) and haloperidol (19.34%). Prescriptions of IACEs and memantine were clustered in those younger than 84 years and antipsychotics in those older than 85 (P<.001). Antipsychotics were maintained for a mean of 1174.5 days. In 26.4% of cases they were prescribed alone, OR 0.61 (95% CI: 0.59-0.62), in 35.85% associated with IACEs, OR 1.26 (95% CI: 1.22-1.30) and in 42.4% with memantine, OR 1.69 (95% CI: 1.62-1.78) (P<.000). From the diagnosis of dementia, 461 days (±1576.5) elapsed when isolated drugs were prescribed; 651 days (±1574.25) associated with IACEs and 1224 (±1779) with memantine. CONCLUSIONS One third of patients with dementia were prescribed antipsychotics, mostly atypical, more frequently in those older than 85 years and for prolonged periods. IACEs and memantine were associated with the risk of antipsychotic prescription, but paradoxically, with prolonged time to onset.
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Affiliation(s)
- Norberto Rodríguez Espinosa
- Unidad de Neurología de la Conducta y Memoria, Servicio de Neurología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, España; Departamento de Medicina, Psiquiatría y Dermatología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna/Santa Cruz de Tenerife, Tenerife, España.
| | - Magali Gonzalez-Colaço Harmand
- Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, España; Universidad Europea de Canarias, La Orotava/Santa Cruz de Tenerife, Tenerife, España
| | - María Adoración Moro Miguel
- Unidad de Neurología de la Conducta y Memoria, Servicio de Neurología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, España
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Jutzeler CR, Bourguignon L, Tong B, Ronca E, Bailey E, Harel NY, Geisler F, Ferguson AR, Kwon BK, Cragg JJ, Grassner L, Kramer JLK. Pharmacological management of acute spinal cord injury: a longitudinal multi-cohort observational study. Sci Rep 2023; 13:5434. [PMID: 37012257 PMCID: PMC10070428 DOI: 10.1038/s41598-023-31773-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Multiple types and classes of medications are administered in the acute management of traumatic spinal cord injury. Prior clinical studies and evidence from animal models suggest that several of these medications could modify (i.e., enhance or impede) neurological recovery. We aimed to systematically determine the types of medications commonly administered, alone or in combination, in the transition from acute to subacute spinal cord injury. For that purpose, type, class, dosage, timing, and reason for administration were extracted from two large spinal cord injury datasets. Descriptive statistics were used to describe the medications administered within the first 60 days after spinal cord injury. Across 2040 individuals with spinal cord injury, 775 unique medications were administered within the two months after injury. On average, patients enrolled in a clinical trial were administered 9.9 ± 4.9 (range 0-34), 14.3 ± 6.3 (range 1-40), 18.6 ± 8.2 (range 0-58), and 21.5 ± 9.7 (range 0-59) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Those enrolled in an observational study were administered on average 1.7 ± 1.7 (range 0-11), 3.7 ± 3.7 (range 0-24), 8.5 ± 6.3 (range 0-42), and 13.5 ± 8.3 (range 0-52) medications within the first 7, 14, 30, and 60 days post-injury, respectively. Polypharmacy was commonplace (up to 43 medications per day per patient). Approximately 10% of medications were administered acutely as prophylaxis (e.g., against the development of pain or infections). To our knowledge, this was the first time acute pharmacological practices have been comprehensively examined after spinal cord injury. Our study revealed a high degree of polypharmacy in the acute stages of spinal cord injury, raising the potential to impact neurological recovery. All results can be interactively explored on the RXSCI web site ( https://jutzelec.shinyapps.io/RxSCI/ ) and GitHub repository ( https://github.com/jutzca/Acute-Pharmacological-Treatment-in-SCI/ ).
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Affiliation(s)
- Catherine R Jutzeler
- Department of Health Sciences and Technology, ETH Zurich, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Lengghalde 2, 8008, Zurich, Switzerland
| | - Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Elias Ronca
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Eric Bailey
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Noam Y Harel
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Weill Institute for Neurosciences, University of California San Francisco (UCSF), San Francisco, CA, USA
- San Francisco Veteran's Affairs Health Care System, San Francisco, CA, USA
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Jacquelyn J Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Hugill Centre for Anesthesia, University of British Columbia, Vancouver, Canada
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Reeve E, Chenoweth L, Sawan M, Nguyen TA, Kalisch Ellett L, Gilmartin-Thomas J, Tan E, Sluggett JK, Quirke LS, Tran K, Ailabouni N, Cowan K, Sinclair R, de la Perrelle L, Deimel J, To J, Daly S, Whitehead C, Hilmer SN. Consumer and Healthcare Professional Led Priority Setting for Quality Use of Medicines in People with Dementia: Gathering Unanswered Research Questions. J Alzheimers Dis 2023; 91:933-960. [PMID: 36530085 PMCID: PMC9912715 DOI: 10.3233/jad-220827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Historically, research questions have been posed by the pharmaceutical industry or researchers, with little involvement of consumers and healthcare professionals. OBJECTIVE To determine what questions about medicine use are important to people living with dementia and their care team and whether they have been previously answered by research. METHODS The James Lind Alliance Priority Setting Partnership process was followed. A national Australian qualitative survey on medicine use in people living with dementia was conducted with consumers (people living with dementia and their carers including family, and friends) and healthcare professionals. Survey findings were supplemented with key informant interviews and relevant published documents (identified by the research team). Conventional content analysis was used to generate summary questions. Finally, evidence checking was conducted to determine if the summary questions were 'unanswered'. RESULTS A total of 545 questions were submitted by 228 survey participants (151 consumers and 77 healthcare professionals). Eight interviews were conducted with key informants and four relevant published documents were identified and reviewed. Overall, analysis resulted in 68 research questions, grouped into 13 themes. Themes with the greatest number of questions were related to co-morbidities, adverse drug reactions, treatment of dementia, and polypharmacy. Evidence checking resulted in 67 unanswered questions. CONCLUSION A wide variety of unanswered research questions were identified. Addressing unanswered research questions identified by consumers and healthcare professionals through this process will ensure that areas of priority are targeted in future research to achieve optimal health outcomes through quality use of medicines.
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Affiliation(s)
- Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, SA, Australia,Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,Correspondence to: Emily Reeve, BPharm(Hons), PhD, Senior Research Fellow, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Victoria 3052, Australia. E-mail:
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Kensington, NSW, Australia
| | - Mouna Sawan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Tuan Anh Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, SA, Australia,National Ageing Research Institute, Parkville, VIC, Australia,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia,Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, SA, Australia
| | - Julia Gilmartin-Thomas
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, VIC, Australia
| | - Edwin Tan
- School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia,UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | | | - Kham Tran
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, SA, Australia,National Ageing Research Institute, Parkville, VIC, Australia,School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia,Health Strategy and Policy Institute, Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Nagham Ailabouni
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, SA, Australia,Pharmacy Australia Centre of Excellence, Health and Behavioural Science Department, School of Pharmacy, University of Queensland, Brisbane, QLD, Australia
| | - Katherine Cowan
- James Lind Alliance, University of Southampton, Southampton, UK
| | - Ron Sinclair
- Consumer advocate, Dementia Australia, Sydney, NSW, Australia
| | - Lenore de la Perrelle
- College of Education, Psychology and Social Work, Flinders University, SA, Australia,College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Judy Deimel
- Central Adelaide Local Health Network (CALHN) Memory Service, Adelaide, SA, Australia
| | - Josephine To
- Division of Aged Care, Rehabilitation and Palliative Care, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Stephanie Daly
- Family Health Medical Group, Adelaide, SA, Australia,Sensus Cognition, Adelaide, SA, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Sarah N. Hilmer
- Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, Australia
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Delara M, Murray L, Jafari B, Bahji A, Goodarzi Z, Kirkham J, Chowdhury Z, Seitz DP. Prevalence and factors associated with polypharmacy: a systematic review and Meta-analysis. BMC Geriatr 2022; 22:601. [PMID: 35854209 PMCID: PMC9297624 DOI: 10.1186/s12877-022-03279-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/06/2022] [Indexed: 12/22/2022] Open
Abstract
Introduction Polypharmacy is commonly associated with adverse health outcomes. There are currently no meta-analyses of the prevalence of polypharmacy or factors associated with polypharmacy. We aimed to estimate the pooled prevalence of polypharmacy and factors associated with polypharmacy in a systematic review and meta-analysis. Methods MEDLINE, EMBASE, and Cochrane databases were searched for studies with no restrictions on date. We included observational studies that reported on the prevalence of polypharmacy among individuals over age 19. Two reviewers extracted study characteristics including polypharmacy definitions, study design, setting, geography, and participant demographics. The risk of bias was assessed using the Newcastle-Ottawa Scales. The main outcome was the prevalence of polypharmacy and factors associated with polypharmacy prevalence. The pooled prevalence estimates of polypharmacy with 95% confidence intervals were determined using random effects meta-analysis. Subgroup analyses were undertaken to evaluate factors associated with polypharmacy such as polypharmacy definitions, study setting, study design and geography. Meta-regression was conducted to assess the associations between polypharmacy prevalence and study year. Results 106 full-text articles were identified. The pooled estimated prevalence of polypharmacy in the 54 studies reporting on polypharmacy in all medication classes was 37% (95% CI: 31-43%). Differences in polypharmacy prevalence were reported for studies using different numerical thresholds, study setting, and publication year. Sex, study geography, study design and geographical location were not associated with differences in polypharmacy prevalence. Discussion Our review highlights that polypharmacy is common particularly among older adults and those in inpatient settings. Clinicians should be aware of populations who have an increased likelihood of experiencing polypharmacy and efforts should be made to review the appropriateness of prescribed medications and occurrence of adverse effects potentially associated with polypharmacy. Conclusions and implications Clinicians should be aware of the common occurrence of polypharmacy and undertake efforts to minimize inappropriate polypharmacy whenever possible. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03279-x.
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Affiliation(s)
- Mahin Delara
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada
| | - Lauren Murray
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada
| | - Behnaz Jafari
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Anees Bahji
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Zahra Goodarzi
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.,Departments of Medicine and Community Health Sciences, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Julia Kirkham
- Cumming School of Medicine, University of Calgary, Room 2919 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Zia Chowdhury
- Department of Psychiatry, Hotchkiss Brain Institute, and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Dallas P Seitz
- Department of Psychiatry, Queen's University, Providence Care-Mental Health Services, Kingston, Ontario, Canada.
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Heikal SA, Salama M, Richard Y, Moustafa AA, Lawlor B. The Impact of Disease Registries on Advancing Knowledge and Understanding of Dementia Globally. Front Aging Neurosci 2022; 14:774005. [PMID: 35197840 PMCID: PMC8859161 DOI: 10.3389/fnagi.2022.774005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2022] [Indexed: 12/01/2022] Open
Abstract
To help address the increasing challenges related to the provision of dementia care, dementia registries have emerged around the world as important tools to gain insights and a better understanding of the disease process. Dementia registries provide a valuable source of standardized data collected from a large number of patients. This review explores the published research relating to different dementia registries around the world and discusses how these registries have improved our knowledge and understanding of the incidence, prevalence, risk factors, mortality, diagnosis, and management of dementia. A number of the best-known dementia registries with high research output including SveDem, NACC, ReDeGi, CREDOS and PRODEM were selected to study the publication output based on their data, investigate the key findings of these registry-based studies. Registries data contributed to understanding many aspects of the disease including disease prevalence in specific areas, patient characteristics and how they differ in populations, mortality risks, as well as the disease risk factors. Registries data impacted the quality of patients’ lives through determining the best treatment strategy for a patient based on previous patient outcomes. In conclusion, registries have significantly advanced scientific knowledge and understanding of dementia and impacted policy, clinical practice care delivery.
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Affiliation(s)
- Shimaa A. Heikal
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- *Correspondence: Shimaa A. Heikal,
| | - Mohamed Salama
- Institute of Global Health and Human Ecology (IGHHE), The American University in Cairo (AUC), New Cairo, Egypt
- Medical Experimental Research Center (MERC), Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yuliya Richard
- Blue Horizon Counseling Services, Sydney, NSW, Australia
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Brian Lawlor
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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GuanXinNing Tablet Attenuates Alzheimer's Disease via Improving Gut Microbiota, Host Metabolites, and Neuronal Apoptosis in Rabbits. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9253281. [PMID: 34745305 PMCID: PMC8568547 DOI: 10.1155/2021/9253281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 01/27/2023]
Abstract
Based on accumulating evidence, Alzheimer's disease (AD) is related to hypercholesterolemia, gut microbiota, and host metabolites. GuanXinNing Tablet (GXN) is an oral compound preparation composed of two Chinese herbs, Salvia miltiorrhiza Bge. and Ligusticum chuanxiong Hort., both of which exert neuroprotective effects. Nevertheless, the effect of GXN on AD is unknown. In the present study, we investigated whether GXN alters cholesterol, amyloid-beta (Aβ), gut microbiota, serum metabolites, oxidative stress, neuronal metabolism activities, and apoptosis in an AD model rabbit fed a 2% cholesterol diet. Our results suggested that the GXN treatment significantly reduced cholesterol levels and Aβ deposition and improved memory and behaviors in AD rabbits. The 16S rRNA analysis showed that GXN ameliorated the changes in the gut microbiota, decreased the Firmicutes/Bacteroidetes ratio, and improved the abundances of Akkermansia and dgA-11_gut_group. 1H-NMR metabolomics found that GXN regulated 12 different serum metabolites, such as low-density lipoprotein (LDL), trimethylamine N-oxide (TMAO), and glutamate (Glu). In addition, the 1H-MRS examination showed that GXN remarkably increased N-acetyl aspartate (NAA) and Glu levels while reducing myo-inositol (mI) and choline (Cho) levels in AD rabbits, consequently enhancing neuronal metabolism activities. Furthermore, GXN significantly inhibited oxidative stress and neuronal apoptosis. Taken together, these results indicate that GXN attenuates AD via improving gut microbiota, host metabolites, and neuronal apoptosis.
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Abstract
OBJECTIVES Nursing home (NH) residents with dementia is exposed to high rates of psychotropic prescriptions. Our objectives were to: (1) pool the prevalence estimates of psychotropic polypharmacy from the existing literature and (2) examine potentially influential factors that are related to a higher or lower prevalence. DESIGN Meta-analysis of data collected from randomized trials, quasi-experimental, prospective or retrospective cohort, and cross-sectional studies. English-language searches of PubMed and PsycINFO were completed by November 2020. Included studies reported prevalence estimates of psychotropic polypharmacy (i.e. defined as either two-or-more or three-or-more medications concurrently) in NH residents with dementia. SETTING AND PARTICIPANTS NH residents with dementia. MEASUREMENTS Random-effects models were used to pool the prevalence of psychotropic polypharmacy in NH residents with dementia across studies. Estimates were provided for both two-or-more and three-or-more concurrent medications. Heterogeneity and publication bias were measured. Meta-regression examined the influence of the percentage of the sample who were male, mean age of the sample, geographic region (continent), sample size, and study year on the prevalence of psychotropic polypharmacy. RESULTS Twenty-five unique articles were included comprising medications data from 92,370 NH residents with dementia in 12 countries. One-in-three (33%, [95% CI: 28%, 39%]) NH residents with dementia received two-or-more psychotropic medications concurrently. One-in-eight (13%, [95% CI: 10%, 17%]) received three-or-more psychotropic medications concurrently. Estimates were highly variable across both definitions of psychotropic polypharmacy (p < 0.001). Among study-level demographics, geographic region, sample size, or study year, only male sex was associated with greater use of two-or-more psychotropic medications (Unadjusted OR = 1.02, p = 0.006; Adjusted OR = 1.04, p = 0.07). CONCLUSIONS Psychotropic polypharmacy is common among NH residents with dementia. Identifying the causes of utilization and the effects on resident health and well-being should be prioritized by federal entities seeking to improve NH quality.
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Ruangritchankul S, Chantharit P, Srisuma S, Gray LC. Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review. Ther Clin Risk Manag 2021; 17:927-949. [PMID: 34511919 PMCID: PMC8427072 DOI: 10.2147/tcrm.s323387] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
The rising of global geriatric population has contributed to increased prevalence of dementia. Dementia is a neurodegenerative disease, which is characterized by progressive deterioration of cognitive functions, such as judgment, language, memory, attention and visuospatial ability. Dementia not only has profoundly devastating physical and psychological health outcomes, but it also poses a considerable healthcare expenditure and burdens. Acetylcholinesterase inhibitors (AChEIs), or so-called anti-dementia medications, have been developed to delay the progression of neurocognitive disorders and to decrease healthcare needs. AChEIs have been widely prescribed in clinical practice for the treatment of Alzheimer's disease, which account for 70% of dementia. The rising use of AChEIs results in increased adverse drug reactions (ADRs) such as cardiovascular and gastrointestinal adverse effects, resulting from overstimulation of peripheral cholinergic activity and muscarinic receptor activation. Changes in pharmacokinetics (PK), pharmacodynamics (PD) and pharmacogenetics (PGx), and occurrence of drug interactions are said to be major risk factors of ADRs of AChEIs in this population. To date, comprehensive reviews in ADRs of AChEIs have so far been scarcely studied. Therefore, we aimed to recapitulate and update the diverse aspects of AChEIs, including the mechanisms of action, characteristics and risk factors of ADRs, and preventive strategies of their ADRs. The collation of this knowledge is essential to facilitate efforts to reduce ADRs of AChEIs.
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Affiliation(s)
- Sirasa Ruangritchankul
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prawat Chantharit
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sahaphume Srisuma
- Ramathibodi Poison Center and Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Joling KJ, Koppel MT, van Hout HP, Onwuteaka‐Philipsen BD, Francke AL, Verheij RA, Twisk JW, van Marum RJ. Psychotropic drug prescription rates in primary care for people with dementia from recorded diagnosis onwards. Int J Geriatr Psychiatry 2021; 36:443-451. [PMID: 33022804 PMCID: PMC7894336 DOI: 10.1002/gps.5442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychotropic drugs are frequently prescribed to people with dementia in nursing homes although severe adverse events and side effects are common. Less is known about the prevalence and types of psychotropic drug prescription in primary care for people with dementia. OBJECTIVE This study examined the prevalence of psychotropic drug prescriptions in primary care among persons with dementia from the year of diagnosis onwards. METHODS A longitudinal observational study using electronic health record (EHR) data was conducted. People with dementia were selected from EHR data of 451 general practices in the Netherlands. Age and gender-adjusted psychotropic drug prescription rates were calculated per 1000 person-years from the year the dementia diagnosis was first recorded in general practice up to 8 years after diagnosis. RESULTS Data of 15,687 patients were analyzed. The prescription rate of psychotropic drugs (not including antidementia drugs) was 420 per 1000 person-years (95% CI 409; 431) in the first year after the recorded dementia diagnosis, which increased to 801 per 1000 person-years (95% CI 649; 989) in the eighth year. The most frequently prescribed drugs were antidepressants, antipsychotics, and antidementia drugs, followed by anxiolytics, hypnotics, and antiepileptics. CONCLUSIONS After a dementia diagnosis is recorded in general practice, the prevalence of psychotropic drug prescriptions is substantial and increases steadily during the disease trajectory of persons with dementia. Although the (in)appropriateness of prescribing was not assessed, these insights may stimulate primary care clinicians to (re)consider their prescription policy of psychotropics for people with dementia more carefully.
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Affiliation(s)
- Karlijn J. Joling
- Department of General Practice and Elderly Care MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Maud ten Koppel
- Department of Public and Occupational Health, Expertise Center for Palliative CareAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Hein P.J. van Hout
- Department of General Practice and Elderly Care MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Bregje D. Onwuteaka‐Philipsen
- Department of Public and Occupational Health, Expertise Center for Palliative CareAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Anneke L. Francke
- Department of Public and Occupational Health, Expertise Center for Palliative CareAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands,Nivel. Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Robert A. Verheij
- Nivel. Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Jos W.R. Twisk
- Department of Epidemiology and BiostatisticsAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Rob J. van Marum
- Department of General Practice and Elderly Care MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstituteAmsterdamThe Netherlands,Geriatric DepartmentJeroen Bosch Hospital‘s‐HertogenboschThe Netherlands
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10
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Oliveira LDF, Camargos EF, Martini LLL, Machado FV, Novaes MRCG. Use of psychotropic agents to treat agitation and aggression in Brazilian patients with Alzheimer's disease: A naturalistic and multicenter study. Psychiatry Res 2021; 295:113591. [PMID: 33271491 DOI: 10.1016/j.psychres.2020.113591] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023]
Abstract
We assessed psychotropic prescribing patterns in the clinical treatment of agitation and aggressive behavior in patients with Alzheimer's disease (AD) treated at specialist outpatient clinics in the Federal District of Brazil. This was a naturalistic, observational, multicenter study of a convenience sample of patients with AD (according to DSM-5) who had behavioral symptoms of aggression and/or agitation at outpatient visits, as assessed by the Neuropsychiatric Inventory (NPI), and required pharmacologic intervention. Participants were recruited in 2018-2019 from 11 AD treatment centers. Sociodemographic and clinical data were collected during routine visits. The sample consisted of 369 older adults with a mean age of 82.3 (SD, 7.7) years. The medications most commonly used in patients with behavioral disorders were antidepressants (79.1%), antipsychotics (70.2%), benzodiazepines (10.6%), and mood stabilizers (9.5%). Quetiapine was the most frequently prescribed antipsychotic medication (48.5%), at a mean dose of 57.4 (SD, 40.7) mg. Citalopram was the most widely used antidepressant medication (32.0%), at a mean daily dose of 24.1 (SD, 8.1) mg. In this sample, two or more pharmacologic agents were frequently used together to control aggression and agitation. Benzodiazepine was not frequently used.
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Affiliation(s)
- Larissa de Freitas Oliveira
- Secretaria de Estado de Saúde do Distrito Federal, Geriatra(Staff geriatrician, Federal District Department of Health), Brasília, DF, Brazil.
| | - Einstein Francisco Camargos
- Hospital Universitário de Brasília, Geriatra(Staff geriatrician, University Hospital of Brasilia), Brasília, DF, Brazil
| | | | - Flávio Vieira Machado
- Programa de pós-graduação em Ciências Médicas, UnB, Psiquiatra(Psychiatrist, Graduate program in Medical Sciences), UnB, Brasília, DF, Brazil
| | - Maria Rita Carvalho Garbi Novaes
- Fundação de Ensino e Pesquisa em Ciências da Saúde, Farmacêutica(Pharmacist, Health Sciences Teaching and Research Foundation), Brasília, DF, Brazil
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11
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Tan ECK, Johnell K, Bell JS, Garcia-Ptacek S, Fastbom J, Nordström P, Eriksdotter M. Do Acetylcholinesterase Inhibitors Prevent or Delay Psychotropic Prescribing in People With Dementia? Analyses of the Swedish Dementia Registry. Am J Geriatr Psychiatry 2020; 28:108-117. [PMID: 31331724 DOI: 10.1016/j.jagp.2019.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To investigate whether acetylcholinesterase inhibitor (AChEI) use prevents or delays subsequent initiation of psychotropic medications in people with Alzheimer's disease (AD) and Lewy body dementia (LBD). METHODS Cohort study of 17,763 people with AD and LBD, without prior psychotropic use at time of dementia diagnosis, registered in the Swedish Dementia Registry from 2007 to 2015. Propensity score-matched regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent AChEI use and risk of psychotropic initiation. RESULTS Compared with matched comparators, AChEI users had a lower risk of antipsychotic (HR: 0.85, 95%CI: 0.75-0.95) and anxiolytic (HR: 0.76, 95%CI: 0.72-0.80) initiation. In subanalyses, this association remained significant at higher AChEI doses, and in AD but not LBD. There were no associations between AChEI use and initiation of antidepressants or hypnotics. CONCLUSION AChEI use may be associated with lower risk of antipsychotic and anxiolytic initiation in AD, particularly at higher doses. Further investigation into aceytylcholinesterase inhibitors in behavioral and psychological symptoms of dementia management in LBD is warranted.
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Affiliation(s)
- Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences (ECKT, JSB), Monash University, Parkville, Australia; The University of Sydney, Faculty of Medicine and Health, School of Pharmacy (ECKT), NSW, Australia; Aging Research Centre, Department of Neurobiology, Care Sciences and Society (ECKT, JF), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics (KJ), Karolinska Institutet, Stockholm, Sweden
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences (ECKT, JSB), Monash University, Parkville, Australia
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (SGP, ME), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Internal Medicine, Section for Neurology (SGP), Södersjukhuset, Stockholm, Sweden
| | - Johan Fastbom
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society (ECKT, JF), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation (PN), Umeå University, Umeå, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (SGP, ME), Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Theme Aging (ME), Karolinska University Hospital, Huddinge, Sweden
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12
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Zhu L, Rochon PA, Gruneir A, Wu W, Giannakeas V, Austin PC, Stall NM, McCarthy L, Alberga A, Herrmann N, Gill SS, Bronskill SE. Sex Differences in the Prevalent Use of Oral Formulations of Cholinesterase Inhibitors in Older Adults with Dementia. Drugs Aging 2019; 36:875-884. [PMID: 31309528 DOI: 10.1007/s40266-019-00690-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cholinesterase inhibitors (ChEIs) are one of only two drug therapies available to manage cognitive decline in dementia. Given sex-specific differences in medication access and effects, it is important to understand how ChEIs are used by women and men. OBJECTIVE The objective of this study was to provide contemporary sex-stratified evidence on patterns of ChEI use by community-dwelling older adults with dementia to inform opportunities to optimize drug prescribing. METHODS We conducted a population-based cross-sectional study examining ChEI use in older adults with dementia in Ontario, Canada. We identified all community-dwelling individuals aged 66 years and older with a pre-existing diagnosis of dementia as of 1 April, 2016. We examined the prevalence of ChEI use among women and men separately, and explored the association between ChEI use and age, sex, income status, geographic location of residence, use of palliative care services, comorbidity, and polypharmacy. Concurrent use of drugs known to impair cognition (including antipsychotics, benzodiazepines, and medications with strong anticholinergic properties) was separately assessed among women and men using multivariable analyses and prevalence risk ratios. RESULTS Of 74,799 women and 52,231 men living with dementia in the community, nearly 30% currently were using a ChEI (29.3% women, 28.6% men). Close to 70% of users were receiving the target therapeutic dose. Compared to men, women were less often taking the target therapeutic dose (67.8% women vs. 71.6% men, p < 0.001). Over 20% of users also were using drugs known to impair cognition, while being treated for cognitive decline using ChEIs. Compared to men, women were more often concurrently using drugs known to impair cognition (23.9% women vs. 21.8% men, p < 0.001). CONCLUSIONS This is one of the first studies of ChEI use to account for important sex differences. The results remind clinicians and researchers that patterns of ChEI therapy use differ by sex, as women were less likely to receive target therapeutic doses and more vulnerable to potentially problematic polypharmacy than men.
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Affiliation(s)
- Lynn Zhu
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Paula A Rochon
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Medicine, University of Toronto, Room 2109, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Andrea Gruneir
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Wei Wu
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Peter C Austin
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada.,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan M Stall
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Medicine, University of Toronto, Room 2109, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Lisa McCarthy
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada
| | - Amanda Alberga
- ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Sudeep S Gill
- ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Medicine, Queen's University, Etherington Hall, Rooms 3032-3043, 94 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Susan E Bronskill
- Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada. .,ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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13
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Kristensen RU, Nørgaard A, Jensen-Dahm C, Gasse C, Wimberley T, Waldemar G. Polypharmacy and Potentially Inappropriate Medication in People with Dementia: A Nationwide Study. J Alzheimers Dis 2019; 63:383-394. [PMID: 29578483 DOI: 10.3233/jad-170905] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use of polypharmacy and PIM in people with dementia is not well-described. OBJECTIVE To examine the prevalence of polypharmacy and PIM in older people with and without dementia in a nationwide population. METHODS Cross-sectional study of the Danish population aged ≥65 in 2014 (n = 1,032,120) based on register data, including information on diagnoses and dispensed prescriptions. Polypharmacy and PIM use among people with (n = 35,476) and without dementia (n = 994,231) were compared, stratified by living situation and adjusted for age, sex, and comorbidity. The red-yellow-green list from the Danish Institute for Rational Pharmacotherapy and the German PRISCUS list were used to define PIM. RESULTS People with dementia were more frequently exposed to polypharmacy (dementia: 62.6% versus no-dementia: 35.1%, p < 0.001) and likewise PIM (red-yellow-green: 45.0% versus 29.7%, p < 0.001; PRISCUS: 24.4% versus 13.2%, p < 0.001). After adjustments for age, sex, and comorbidity, the likelihood of polypharmacy and PIM was higher for community-dwelling people with dementia than without dementia (odds ratio (OR); [95% confidence interval (CI)] polypharmacy: 1.50 [1.45-1.55]; red-yellow-green: 1.27 [1.23-1.31]; PRISCUS: 1.25 [1.20-1.30]). In contrast, dementia slightly decreased the odds of polypharmacy and PIM in nursing home residents. CONCLUSION Use of polypharmacy and PIM were widespread in the older population and more so in people with dementia. This could have negative implications for patient-safety and demonstrates the need for interventions to improve drug therapy in people with dementia.
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Affiliation(s)
- Rachel Underlien Kristensen
- Department of Neurology, Danish Dementia Research Centre (DDRC), Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Ane Nørgaard
- Department of Neurology, Danish Dementia Research Centre (DDRC), Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christina Jensen-Dahm
- Department of Neurology, Danish Dementia Research Centre (DDRC), Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christiane Gasse
- National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark.,CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Theresa Wimberley
- National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre (DDRC), Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
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14
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Valladales‐Restrepo LF, Duran‐Lengua M, Machado‐Alba JE. Potentially inappropriate prescriptions of anticholinergics drugs in Alzheimer's disease patients. Geriatr Gerontol Int 2019; 19:913-917. [DOI: 10.1111/ggi.13748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/04/2019] [Accepted: 07/02/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Luis Fernando Valladales‐Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira‐Audifarma S.A Pereira Colombia
- Grupo de Biomedicina, Fundación Universitaria Autónoma de las Américas Pereira Colombia
| | | | - Jorge Enrique Machado‐Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnologica de Pereira‐Audifarma S.A Pereira Colombia
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15
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Identifying potentially inappropriate prescribing in older people with dementia: a systematic review. Eur J Clin Pharmacol 2019; 75:467-481. [PMID: 30610274 DOI: 10.1007/s00228-018-02612-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/13/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Older people with dementia are at risk of adverse events associated with potentially inappropriate prescribing. AIM to describe (1) how international tools designed to identify potentially inappropriate prescribing have been used in studies of older people with dementia, (2) the prevalence of potentially inappropriate prescribing in this cohort and (3) advantages/disadvantages of tools METHODS: Systematic literature review, designed and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, EMBASE, PsychInfo, CINAHL, the Cochrane Library, the Social Science Citation Index, OpenGrey, Base, GreyLit, Mednar and the National Database of Ageing Research were searched in April 2016 for studies describing the use of a tool or criteria to identify potentially inappropriate prescribing in older people with dementia. RESULTS Three thousand three hundred twenty-six unique papers were identified; 26 were included in the review. Eight studies used more than one tool to identify potentially inappropriate prescribing. There were variations in how the tools were applied. The Beers criteria were the most commonly used tool. Thirteen of the 15 studies using the Beers criteria did not use the full tool. The prevalence of potentially inappropriate prescribing ranged from 14 to 74% in older people with dementia. Benzodiazepines, hypnotics and anticholinergics were the most common potentially inappropriately prescribed medications. CONCLUSIONS Variations in tool application may at least in part explain variations in potentially inappropriate prescribing across studies. Recommendations include a more standardised tool usage and ensuring the tools are comprehensive enough to identify all potentially inappropriate medications and are kept up to date.
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16
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Lexomboon D, Tan ECK, Höijer J, Garcia-Ptacek S, Eriksdotter M, Religa D, Fastbom J, Johnell K, Sandborgh-Englund G. The Effect of Xerostomic Medication on Oral Health in Persons With Dementia. J Am Med Dir Assoc 2018; 19:1080-1085.e2. [DOI: 10.1016/j.jamda.2018.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/17/2018] [Accepted: 05/20/2018] [Indexed: 12/11/2022]
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17
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Pisa FE, Palese F, Romanese F, Barbone F, Logroscino G, Riedel O. How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data. Int J Methods Psychiatr Res 2018; 27:e1724. [PMID: 29869820 PMCID: PMC7133096 DOI: 10.1002/mpr.1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. METHODS We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. RESULTS Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). CONCLUSION Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used.
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Affiliation(s)
- Federica Edith Pisa
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | | | | | - Fabio Barbone
- Department of Medicine, University of Udine, Udine, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Basic Medicine Neuroscience and Sense Organs, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, University of Bari, Lecce, Italy
| | - Oliver Riedel
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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18
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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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19
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Pan Y, Xu J, Chen C, Chen F, Jin P, Zhu K, Hu CW, You M, Chen M, Hu F. Royal Jelly Reduces Cholesterol Levels, Ameliorates Aβ Pathology and Enhances Neuronal Metabolic Activities in a Rabbit Model of Alzheimer's Disease. Front Aging Neurosci 2018; 10:50. [PMID: 29556189 PMCID: PMC5845009 DOI: 10.3389/fnagi.2018.00050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/15/2018] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia characterized by aggregation of amyloid β (Aβ) and neuronal loss. One of the risk factors for AD is high cholesterol levels, which are known to promote Aβ deposition. Previous studies have shown that royal jelly (RJ), a product of worker bees, has potential neuroprotective effects and can attenuate Aβ toxicity. However, little is known about how RJ regulates Aβ formation and its effects on cholesterol levels and neuronal metabolic activities. Here, we investigated whether RJ can reduce cholesterol levels, regulate Aβ levels and enhance neuronal metabolic activities in an AD rabbit model induced by 2% cholesterol diet plus copper drinking water. Our results suggest that RJ significantly reduced the levels of plasma total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C), and decreased the level of Aβ in rabbit brains. RJ was also shown to markedly ameliorate amyloid deposition in AD rabbits from Aβ immunohistochemistry and thioflavin-T staining. Furthermore, our study suggests that RJ can reduce the expression levels of β-site APP cleaving enzyme-1 (BACE1) and receptor for advanced glycation end products (RAGE), and increase the expression levels of low density lipoprotein receptor-related protein 1 (LRP-1) and insulin degrading enzyme (IDE). In addition, we found that RJ remarkably increased the number of neurons, enhanced antioxidant capacities, inhibited activated-capase-3 protein expression, and enhanced neuronal metabolic activities by increasing N-acetyl aspartate (NAA) and glutamate and by reducing choline and myo-inositol in AD rabbits. Taken together, our data demonstrated that RJ could reduce cholesterol levels, regulate Aβ levels and enhance neuronal metabolic activities in AD rabbits, providing preclinical evidence that RJ treatment has the potential to protect neurons and prevent AD.
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Affiliation(s)
- Yongming Pan
- College of Animal Sciences, Zhejiang University, Hangzhou, China.,Comparative Medical Research Center, Experimental Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianqin Xu
- Comparative Medical Research Center, Experimental Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Cheng Chen
- Comparative Medical Research Center, Experimental Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fangming Chen
- Comparative Medical Research Center, Experimental Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ping Jin
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Keyan Zhu
- Comparative Medical Research Center, Experimental Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenyue W Hu
- Department of Bioengineering, Rice University, Houston, TX, United States
| | - Mengmeng You
- College of Animal Sciences, Zhejiang University, Hangzhou, China
| | - Minli Chen
- Comparative Medical Research Center, Experimental Animal Research Center, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fuliang Hu
- College of Animal Sciences, Zhejiang University, Hangzhou, China
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20
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David R, Manera V, Fabre R, Pradier C, Robert P, Tifratene K. Evolution of the Antidepressant Prescribing in Alzheimer's Disease and Related Disorders Between 2010 and 2014: Results from the French National Database on Alzheimer's Disease (BNA). J Alzheimers Dis 2018; 53:1365-73. [PMID: 27392860 DOI: 10.3233/jad-160238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Safety warnings from health authorities are currently intended to limit the use of psychotropic agents in dementia-related conditions. Evidence concerning the use of antidepressants in dementia is, however, scarce and contradictory. OBJECTIVE To evaluate antidepressant use among individuals with Alzheimer's disease (AD) and related disorders in the French population between 2010 and 2014. METHOD Antidepressant prescriptions in individuals with AD, mixed dementia (MD), and vascular dementia (VaD) in the French National Alzheimer Database between 2010 and 2014 were analyzed (N = 199,544). RESULTS Multivariate analysis showed an annual significant increase (p < 0.001) in the prescription rate of antidepressants from 26% (2010) to 31% (2014), and identified female gender, younger age, higher education, living in long-term facilities, more severe cognitive decline, and presence of vascular signs (VaD and MD) as associated factors for antidepressant prescribing. CONCLUSION The annual increase of antidepressant prescribing among individuals with AD, MD, and VaD in French specialized settings may be partially related to the lack of current valuable medications for dementia-related behavioral symptoms.
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Affiliation(s)
- Renaud David
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Research Memory Centre, Nice University Hospital, Nice, France
| | - Valeria Manera
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France
| | - Roxane Fabre
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Department of Public Health, L'Archet Hospital, Nice University Hospital, Nice, France
| | - Christian Pradier
- Department of Public Health, L'Archet Hospital, Nice University Hospital, Nice, France
| | - Philippe Robert
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Research Memory Centre, Nice University Hospital, Nice, France
| | - Karim Tifratene
- EA Cobtek, University of Nice Sophia-Antipolis, Nice, France.,Department of Public Health, L'Archet Hospital, Nice University Hospital, Nice, France
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21
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Garre-Olmo J, Garcia-Ptacek S, Calvó-Perxas L, Turró-Garriga O, López-Pousa S, Eriksdotter M. Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi). J Alzheimers Dis 2018; 53:1341-51. [PMID: 27392854 PMCID: PMC5115613 DOI: 10.3233/jad-160098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer’s disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03–3.84) for VaD, and 2.15 (1.97–2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39–0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.
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Affiliation(s)
- Josep Garre-Olmo
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain.,Deparment of Medical Sciences, University of Girona, Girona, Catalonia, Spain
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Laia Calvó-Perxas
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Oriol Turró-Garriga
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Secundino López-Pousa
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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22
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Borsje P, Lucassen PLBJ, Wetzels RB, Pot AM, Koopmans RTCM. Neuropsychiatric symptoms and psychotropic drug use in patients with dementia in general practices. Fam Pract 2018; 35:22-28. [PMID: 28985387 DOI: 10.1093/fampra/cmx061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) frequently occur in community-dwelling patients with dementia and they are also frequently prescribed psychotropic drugs. The prescription of psychotropic drugs has been found to be associated with the level of NPS. Data on NPS in patients with dementia in general practices are scarce. OBJECTIVES The aim of this study was to assess the prevalence rates of NPS and psychotropic drug use (PDU) in patients with dementia in general practices. METHODS We analyzed data from the baseline measurement of a prospective cohort study in a sample of (Dutch) patients in general practices. Prevalence rates of NPS and subsyndromes assessed with the Neuropsychiatric Inventory (NPI) and of PDU were calculated. Prevalence rates of individual NPS are presented both as clinically relevant symptoms (NPI symptom score ≥ 4) and as prevalence rates of symptoms with symptom score > 0. RESULTS Of the 117 patients, more than 90% had at least one symptom and more than 65% had at least one clinically relevant symptom. The most common NPS were agitation/aggression, dysphoria/depression and irritability/lability. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference. Only 28.7% of the patients used at least one, 7.0% used at least two different and 1.7% used at least three different types of psychotropic drugs (excluding anti-dementia medication). CONCLUSIONS NPS are highly prevalent in patients with dementia in general practices, but PDU is rather low. The most common clinically relevant NPS were aberrant motor behaviour, agitation/aggression and apathy/indifference.
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Affiliation(s)
- Petra Borsje
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands.,Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands.,Thebe, Region South-East, Goirle, The Netherlands
| | - Peter L B J Lucassen
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands
| | - Roland B Wetzels
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,School of Psychology, The University of Queensland, St Lucia, Australia
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands.,Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands.,Joachim end Anna, Centre for specialized geriatric care, Nijmegen, The Netherlands
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23
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Use of psychotropic medications in relation to neuropsychiatric symptoms, cognition and functional performance in Alzheimer's disease over a three-year period: Kuopio ALSOVA study. Int Psychogeriatr 2017. [PMID: 28625207 DOI: 10.1017/s1041610217001090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychotropic medications are widely prescribed to manage neuropsychiatric symptoms (NPS) of Alzheimer's disease (AD). Our objective was to investigate the longitudinal associations between psychotropic medication use and NPS, cognition, and functional performance in persons with very mild or mild AD at baseline. METHODS Data were collected as part of the prospective three-year study of home-dwelling persons with AD and their caregivers (n = 236 dyads). The associations between psychotropic medication use and clinical measures were analyzed using repeated measures Generalized Estimating Equation (GEE) models. NPS, cognition, daily functioning, and disease severity were assessed with NPI, CERAD-NB, or MMSE, ADCS-ADL, and CDR-SOB, respectively. All analyses were adjusted for age, gender, education, and co-morbidities. RESULTS The prevalence of benzodiazepines and related medications increased from 16% to 24% (p = 0.031), antidepressants from 11% to 18% (p = 0.057), and antipsychotics from 4% to 16% (p = 0.011) in the three years following AD diagnosis. In adjusted multivariable analyses, a one-point increase in NPI increased the odds of using any psychotropic medication class by 4% (odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01-1.07). ADCS-ADL (1/OR 1.04, 95% CI 1.02-1.06) and CDR-SOB (OR 1.27, 95% CI 1.13-1.42) were associated with use of antipsychotics. CERAD-NB and MMSE were not associated with any psychotropic medication class use in the models. CONCLUSIONS Psychotropic medication use increased significantly in relation to increasing dependency in AD, especially with NPS. Furthermore, the use of antipsychotics increased with disease severity, and with decline in daily functioning. Cognitive performance was not associated with psychotropic medication use.
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24
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Reeve E, Trenaman SC, Rockwood K, Hilmer SN. Pharmacokinetic and pharmacodynamic alterations in older people with dementia. Expert Opin Drug Metab Toxicol 2017; 13:651-668. [DOI: 10.1080/17425255.2017.1325873] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Shanna C Trenaman
- Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Kenneth Rockwood
- Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- DGI Clinical Inc., Halifax, Canada
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
- Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, NSW, Australia
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25
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Clague F, Mercer SW, McLean G, Reynish E, Guthrie B. Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data. Age Ageing 2017; 46:33-39. [PMID: 28181629 DOI: 10.1093/ageing/afw176] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/13/2016] [Indexed: 01/14/2023] Open
Abstract
Background The care of older people with dementia is often complicated by physical comorbidity and polypharmacy, but the extent and patterns of these have not been well described. This paper reports analysis of these factors within a large, cross-sectional primary care data set. Methods Data were extracted for 291,169 people aged 65 years or older registered with 314 general practices in the UK, of whom 10,258 had an electronically recorded dementia diagnosis. Differences in the number and type of 32 physical conditions and the number of repeat prescriptions in those with and without dementia were examined. Age–gender standardised rates were used to calculate odds ratios (ORs) of physical comorbidity and polypharmacy. Results People with dementia, after controlling for age and sex, had on average more physical conditions than controls (mean number of conditions 2.9 versus 2.4; P < 0.001) and were on more repeat medication (mean number of repeats 5.4 versus 4.2; P < 0.001). Those with dementia were more likely to have 5 or more physical conditions (age–sex standardised OR [sOR] 1.42, 95% confidence interval (CI) 1.35–1.50; P < 0.001) and were also more likely to be on 5 or more (sOR 1.46; 95% CI 1.40–1.52; P < 0.001) or 10 or more repeat prescriptions (sOR 2.01; 95% CI 1.90–2.12; P < 0.001). Conclusions People with dementia have a higher burden of comorbid physical disease and polypharmacy than those without dementia, even after accounting for age and sex differences. Such complex needs require an integrated response from general health professionals and multidisciplinary dementia specialists.
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Affiliation(s)
- Fiona Clague
- Perth Area Psychological Therapies Service, Murray Royal Hospital, Perth PH2 7BH, UK
| | - Stewart W Mercer
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Gary McLean
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Emma Reynish
- Department of Geriatric Medicine, NHS Lothian, Royal Infirmary, Edinburgh, UK
- School of Applied Social Science, University of Stirling, Stirling, UK
| | - Bruce Guthrie
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, Tayside, UK
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26
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Sverdrup Efjestad A, Ihle-Hansen H, Hjellvik V, Blix HS. Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors. Dement Geriatr Cogn Dis Extra 2017; 7:30-40. [PMID: 28413414 PMCID: PMC5346931 DOI: 10.1159/000454948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/05/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS Reduced clinical effect on cognitive decline in dementia by acetylcholinesterase inhibitors (AChEIs) may be due to concurrent use of drugs with anticholinergic properties. The aim was to analyze the incidence of AChEI use and comedication with drugs with anticholinergic properties and other potential unfavorable effects. METHODS A prospective study applying drug use data from the Norwegian Prescription Database. Anticholinergic Drug Scale (ADS) scores were used as a measure of overall anticholinergic burden. RESULTS Patients with high ADS scores were more frequently discontinuing treatment early. Coprescribing of antipsychotics was strongly associated with early discontinuation of AChEI treatment. CONCLUSION Coprescribing with potentially unfavorable medications was common. A high ADS score was associated with early discontinuation of treatment.
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Affiliation(s)
- Anne Sverdrup Efjestad
- Baerum Hospital Pharmacy, Hospital Pharmacy Enterprises, South Eastern Norway, Gjettum, Norway
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27
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Li X, Zhu H, Sun X, Zuo F, Lei J, Wang Z, Bao X, Wang R. Human Neural Stem Cell Transplantation Rescues Cognitive Defects in APP/PS1 Model of Alzheimer's Disease by Enhancing Neuronal Connectivity and Metabolic Activity. Front Aging Neurosci 2016; 8:282. [PMID: 27932977 PMCID: PMC5120101 DOI: 10.3389/fnagi.2016.00282] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/10/2016] [Indexed: 12/16/2022] Open
Abstract
Alzheimer’s disease (AD), the most frequent type of dementia, is featured by Aβ pathology, neural degeneration and cognitive decline. To date, there is no cure for this disease. Neural stem cell (NSC) transplantation provides new promise for treating AD. Many studies report that intra-hippocampal transplantation of murine NSCs improved cognition in rodents with AD by alleviating neurodegeneration via neuronal complement or replacement. However, few reports examined the potential of human NSC transplantation for AD. In this study, we implanted human brain-derived NSCs (hNSCs) into bilateral hippocampus of an amyloid precursor protein (APP)/presenilin 1 (PS1) transgenic (Tg) mouse model of AD to test the effects of hNSC transplantation on Alzheimer’s behavior and neuropathology. Six weeks later, transplanted hNSCs engrafted into the brains of AD mice, migrated dispersedly in broad brain regions, and some of them differentiated into neural cell types of central nervous system (CNS). The hNSC transplantation restored the recognition, learning and memory deficits but not anxiety tasks in AD mice. Although Aβ plaques were not significantly reduced, the neuronal, synaptic and nerve fiber density was significantly increased in the frontal cortex and hippocampus of hNSC-treated AD mice, suggesting of improved neuronal connectivity in AD brains after hNSC transplantation. Ultrastructural analysis confirmed that synapses and nerve fibers maintained relatively well-structured shapes in these mice. Furthermore, in vivo magnetic resonance spectroscopy (MRS) showed that hNSC-treated mice had notably increased levels of N-acetylaspartate (NAA) and Glu in the frontal cortex and hippocampus, suggesting that neuronal metabolic activity was improved in AD brains after hNSC transplantation. These results suggest that transplanted hNSCs rescued Alzheimer’s cognition by enhancing neuronal connectivity and metabolic activity through a compensation mechanism in APP/PS1 mice. This study provides preclinical evidence that hNSC transplantation can be a possible and feasible strategy for treating patients with AD.
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Affiliation(s)
- Xueyuan Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Hua Zhu
- Department of Pathology, Comparative Medical Center, Peking Union Medical College and Institute of Laboratory Animal Science, Chinese Academy of Medical Science Beijing, China
| | - Xicai Sun
- Center for Stem Cell Biology and Regenerative Medicine, Center for Life Sciences, School of Medicine, Tsinghua University Beijing, China
| | - Fuxing Zuo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Jianfeng Lei
- Center for Medical Experiments and Testing, Capital Medical University Beijing, China
| | - Zhanjing Wang
- Center for Stem Cell Biology and Regenerative Medicine, Center for Life Sciences, School of Medicine, Tsinghua University Beijing, China
| | - Xinjie Bao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing, China
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28
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Fereshtehnejad SM, Johannsen P, Waldemar G, Eriksdotter M. Dementia Diagnosis, Treatment, and Care in Specialist Clinics in Two Scandinavian Countries: A Data Comparison between the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry. J Alzheimers Dis 2016; 48:229-39. [PMID: 26401943 DOI: 10.3233/jad-150144] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Two dementia quality registries have been developed in Denmark and Sweden with the aim to assess quality of dementia care based on adherence to national guidelines. OBJECTIVE To compare patient characteristics, diagnostics, treatment, and quality indicators of dementia care among patients referred to specialist units in Sweden and Denmark. METHODS Data from the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry were merged. Newly diagnosed dementia cases referred to memory clinics during 2007-2012 were included (19,629 Swedish and 6,576 Danish patients). RESULTS The median duration between initial assessment and confirmed diagnosis was 56 and 57 days in Sweden and Denmark, respectively. Brain imaging using MRI was twice as common in Sweden. A diagnosis of dementia was established at an average MMSE of 21. An etiological diagnosis was concluded in 89.6% of the Swedish and 87.3% of the Danish cases. Alzheimer's disease (AD) was the most common disorder (47.7% in Denmark and 36.6% in Sweden); however, more cases were diagnosed as mixed AD in Sweden (24.7% versus 10.6% ). More than 80% of patients with AD, dementia with Lewy bodies, and Parkinson's disease with dementia were treated with anti-dementia drugs. CONCLUSION The targets of several quality indicators in both registries were met, such that structural brain imaging and MMSE were performed in >90% and an etiological diagnosis was concluded in >80% of the patients. However, there were also results of concern. The diagnosis of dementia was established at a mean MMSE of 21, which is already late in the course of most dementia disorders. A higher chance of vascular findings following the higher rate of MRI in Sweden may have resulted in more mixed AD diagnosis, which could be one explanation for diagnostic differences but also highlights the need to harmonize diagnostic criteria.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences, and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Johannsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences, and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
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Johnell K. Inappropriate Drug Use in People with Cognitive Impairment and Dementia: A Systematic Review. ACTA ACUST UNITED AC 2016; 10:178-84. [PMID: 26054404 PMCID: PMC4997919 DOI: 10.2174/1574884710666150609154741] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/16/2014] [Accepted: 05/02/2014] [Indexed: 11/22/2022]
Abstract
The aim of this systematic review was to identify, assess and summarize studies about potentially inappropriate drug use (IDU) in cognitive impairment and dementia and to present findings about whether cognitive impairment and dementia are associated with IDU. The search was made in Medline/PubMed using free terms in the title or abstract. The inclusion criteria were: English language, published until 1 March 2014, original quantitative study and assessment of overall IDU with a consensus based summarized measure. Exclusion criteria were: focus on specific patient group (other than cognitive impairment or dementia), focus on specific drug class and failure to present a prevalence measure of IDU or an effect estimate (i.e. odds ratio). Of the initial 182 studies found in Medline, 22 articles fulfilled the criteria. Most studies used the Beers criteria for assessment of IDU. Prevalence of IDU among individuals with cognitive impairment or dementia ranged from 10.2% to 56.4% and was higher in nursing home settings than in community-dwelling samples. Most studies reported a lower likelihood of IDU in case of cognitive impairment or dementia. To conclude, IDU is highly prevalent among persons with cognitive impairment and dementia, although these conditions seem to be associated with a lower probability of IDU. This might reflect an awareness among clinicians of cautious prescribing to this vulnerable group of patients. More studies on large cohorts of persons with cognitive impairment and dementia are needed to draw conclusions about optimal drug prescribing to this frail group of older persons.
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Affiliation(s)
- Kristina Johnell
- Aging Research Center, Karolinska Institutet, Gävlegatan 16, 113 30 Stockholm, Sweden.
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Trends in Psychotropic Dispensing Among Older Adults with Dementia Living in Long-Term Care Facilities: 2004-2013. Am J Geriatr Psychiatry 2015; 23:1259-1269. [PMID: 26525997 DOI: 10.1016/j.jagp.2015.07.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/30/2015] [Accepted: 07/07/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities. METHODS We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and sedative antidepressants, anti-epileptics, and benzodiazepines. We used time-series analysis to assess trends over time. RESULTS The study sample increased by 21% over the 10-year study period, from 49,251 patients to 59,785 patients. The majority of patients (within the range of 75%-79%) were dispensed at least one psychotropic medication. At the beginning of the study period atypical antipsychotics (38%) were the most frequently dispensed psychotropic, followed by benzodiazepines (28%), non-sedative antidepressants (27%), sedative antidepressants (17%), anti-epileptics (7%), and conventional antipsychotics (3%). Dispensing of anti-epileptics (2% increase) and conventional antipsychotics (1% decrease) displayed modest changes over time, but we observed more pronounced changes in dispensing of benzodiazepines (11% decrease) and atypical antipsychotics (4% decrease). Concurrently, we observed a substantial growth in the dispensing of both sedative (15% increase) and non-sedative (9% increase) antidepressants. The proportion of patients dispensed two or more psychotropic drug classes increased from 42% in 2004 to 50% in 2013. CONCLUSIONS Utilization patterns of psychotropic drugs in institutionalized patients with dementia have changed over the past decade. Although their use declined slightly over the study period, atypical antipsychotics continue to be used at a high rate. A decline in the use of benzodiazepines along with an increased use of sedative and non-sedative antidepressants suggests that the latter class of drugs is being substituted for the former in the management of neuropsychiatric symptoms. Psychotropic polypharmacy continues to be highly prevalent in these patient samples.
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31
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Bohlken J, Schulz M, Rapp MA, Bätzing-Feigenbaum J. Pharmacotherapy of dementia in Germany: Results from a nationwide claims database. Eur Neuropsychopharmacol 2015; 25:2333-8. [PMID: 26476703 DOI: 10.1016/j.euroneuro.2015.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/10/2015] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
Abstract
In 2011, about 1.1-1.4 million patients with dementia were living in Germany, a number expected to rise to three million by 2050. Dementia poses a major challenge to the healthcare system and neuropharmacological service provision. The aim of this study was to determine prescription rates for anti-dementia drugs as well as for neuroleptics, sedative-hypnotics and antidepressants in dementia using the complete nationwide outpatient claims data pertaining to the services of statutory health insurance. We controlled for gender, age, dementia diagnosis, physician specialty (general practitioner GP versus neuropsychiatry specialist physician NPSP), and rural and urban living area. In about one million prevalent dementia patients (N=1,014,710) in 2011, the prescription prevalence rate of anti-dementia drugs was 24.6%; it varied with gender, age, and diagnosis (highest in Alzheimer's disease; 42%), and was higher in patients treated by NPSPs (48% vs. 25% in GPs). At the same time, we found an alarmingly high rate of treatment with neuroleptics in dementia patients (35%), with an only slightly decreased risk in patients treated exclusively by NPSPs (OR=0.86). We found marginal differences between rural and urban areas. Our results show that the majority of anti-dementia drug prescriptions appear guideline-oriented, yet prescription rates are overall comparatively low. On the other hand, neuroleptic drugs, which are associated with excess morbidity and mortality in dementia, were prescribed very frequently, suggesting excess use given current guidelines. We therefore suggest that guideline implementation measures and increasing quality control procedures are needed with respect to the pharmacotherapy of this vulnerable population.
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Affiliation(s)
| | - Mandy Schulz
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Berlin, Germany
| | - Michael A Rapp
- Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, D-14469 Potsdam, Germany.
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Falahati F, Fereshtehnejad SM, Religa D, Wahlund LO, Westman E, Eriksdotter M. The use of MRI, CT and lumbar puncture in dementia diagnostics: data from the SveDem Registry. Dement Geriatr Cogn Disord 2015; 39:81-91. [PMID: 25358376 DOI: 10.1159/000366194] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The use of structural brain imaging [computed tomography (CT)/magnetic resonance imaging (MRI)] and the analysis of cerebrospinal fluid biomarkers are included in the guidelines for the diagnosis of dementia. The influence of variables such as age, gender and disease severity on the use of MRI, CT and lumbar puncture (LP) for the differential diagnosis of dementia and the consonance with the recommendations of the Swedish national guidelines were investigated. METHODS From the National Swedish Dementia Registry (SveDem), 17,057 newly diagnosed dementia patients were included in our study, with the majority from specialist care units (90%). RESULTS In the diagnostic workup, a CT was performed in 87%, MRI in 16% and LP in 40% of the cases. Age (p < 0.001) and cognitive status (p < 0.001) significantly influenced the use of MRI, CT or LP. Older patients with severe dementia were often investigated with CT. LP and MRI were used more often when less common dementia disorders were suspected. CONCLUSION Our findings indicate that age, severity of cognitive impairment and the type of dementia disorder suspected are determinants for the choice of CT, MRI or LP. The majority of the dementia workups in specialist care units follow the recommendations of the Swedish national guidelines where CT is performed as a basic workup, and MRI and LP are chosen when extended workup is needed. .
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Affiliation(s)
- Farshad Falahati
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Wastesson JW, Ringbäck Weitoft G, Johnell K. Educational disparities in antipsychotic drug use among older people with and without dementia in Sweden. Acta Psychiatr Scand 2015; 132:20-8. [PMID: 25532774 DOI: 10.1111/acps.12378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Antipsychotic drugs are commonly used to treat behavioural and psychological symptoms of dementia. The aim was to investigate if socioeconomic position was associated with antipsychotic drug treatment among older adults with and without dementia. METHOD By record linkage of the Swedish Prescribed Drug Register, Patient Register, and Educational Register, we obtained information on antipsychotics, dementia status, and educational level for 641,566 persons aged 75-89 year old in Sweden 2005. RESULTS Among persons diagnosed with dementia (n = 32 092), 21% used antipsychotics compared with 4% in the total sample (n = 641,566). Lower education was associated with a higher probability of antipsychotic use in the total sample (adjusted odds ratio [OR] low vs. high education: 1.56; 95% confidence interval [CI]: 1.48-1.64). In the dementia subpopulation, lower education was also associated with a higher likelihood of use of antipsychotics (adjusted OR(low vs. high) 1.43; 95% CI: 1.28-1.59). CONCLUSION People with dementia were five times more likely to use antipsychotic drugs than the general population of older adults. Also, lower education was associated with a higher use of antipsychotics, both in the general population and in the subgroup of persons with dementia. This finding highlights the importance of investigating healthcare inequalities also among cognitively impaired older adults.
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Affiliation(s)
- J W Wastesson
- Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | | | - K Johnell
- Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden
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Religa D, Fereshtehnejad SM, Cermakova P, Edlund AK, Garcia-Ptacek S, Granqvist N, Hallbäck A, Kåwe K, Farahmand B, Kilander L, Mattsson UB, Nägga K, Nordström P, Wijk H, Wimo A, Winblad B, Eriksdotter M. SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice. PLoS One 2015; 10:e0116538. [PMID: 25695768 PMCID: PMC4335024 DOI: 10.1371/journal.pone.0116538] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. METHODS SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. RESULTS The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. CONCLUSION SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.
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Affiliation(s)
- Dorota Religa
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Seyed-Mohammad Fereshtehnejad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Pavla Cermakova
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | | | - Sara Garcia-Ptacek
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | | | | | | | - Bahman Farahmand
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Ulla-Britt Mattsson
- Neuropsychiatric clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Helle Wijk
- Sahlgrenska Academy, Institute of Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
| | - Anders Wimo
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Maria Eriksdotter
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
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Fereshtehnejad SM, Damangir S, Cermakova P, Aarsland D, Eriksdotter M, Religa D. Comorbidity profile in dementia with Lewy bodies versus Alzheimer's disease: a linkage study between the Swedish Dementia Registry and the Swedish National Patient Registry. ALZHEIMERS RESEARCH & THERAPY 2014; 6:65. [PMID: 25478027 PMCID: PMC4255539 DOI: 10.1186/s13195-014-0065-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/05/2014] [Indexed: 01/28/2023]
Abstract
Introduction Compared to Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) is usually associated with a more complex clinical picture and higher burden of care. Yet, few investigations have been performed on comorbidities and risk factors of DLB. Therefore, we aimed to compare clinical risk factors and comorbidity profile in DLB and AD patients using two nationwide registries. Methods This is a linkage study between the Swedish dementia registry (SveDem) and the Swedish National Patient Registry conducted on 634 subjects with DLB and 9161 individuals with AD registered during the years 2007–2012. Comorbidity profile has been coded according to the International Classification of Diseases version 10 (ICD 10) in addition to the date of each event. The main chapters of the ICD-10, the Charlson score of comorbidities and a selected number of neuropsychiatric diseases were compared between the DLB and AD groups. Comorbidity was registered before and after the dementia diagnosis. Results “Mental and behavioral disorders”, “diseases of the nervous system”, “diseases of the eye and adnexa”, diseases of the “circulatory”, “respiratory”, and “genitourinary” systems, “diseases of the skin and subcutaneous tissue” and “diseases of the musculoskeletal system and connective tissue” occurred more frequently in the DLB group after multivariate adjustment. Depression [adjusted OR = 2.12 (95%CI 1.49 to 3.03)] and migraine [adjusted OR = 3.65 (95%CI 1.48 to 9.0)] were more commonly recorded before the diagnosis of dementia in the DLB group. Following dementia diagnosis, ischemic stroke [adjusted OR = 1.89 (95%CI 1.21 to 2.96)] was more likely to happen among the DLB patients compared to the AD population. Conclusions Our study indicated a worse comorbidity profile in DLB patients with higher occurrence of depression, stroke and migraine compared with the AD group. Deeper knowledge about the underlying mechanisms of these associations is needed to explore possible reasons for the different pattern of comorbidity profile in DLB compared to AD and their prognostic significance.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Soheil Damangir
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Pavla Cermakova
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden ; International Clinical Research Center and St. Anne's University Hospital, Brno, Czech Republic
| | - Dag Aarsland
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden ; Centre for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Dorota Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
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Cermakova P, Fereshtehnejad SM, Johnell K, Winblad B, Eriksdotter M, Religa D. Cardiovascular medication burden in dementia disorders: a nationwide study of 19,743 dementia patients in the Swedish Dementia Registry. ALZHEIMERS RESEARCH & THERAPY 2014; 6:34. [PMID: 25024749 PMCID: PMC4095690 DOI: 10.1186/alzrt264] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/03/2014] [Indexed: 12/29/2022]
Abstract
Introduction Administration of several cardiovascular drugs has an effect on dementia. We aimed to investigate whether there are differences in the use of cardiovascular medication between different dementia disorders. Methods We obtained information about dementia patients from the Swedish Dementia Registry. Patients were diagnosed with one of these dementia disorders: Alzheimer’s disease (n = 8,139), mixed dementia (n = 5,203), vascular dementia (n = 4,982), Lewy body dementia (n = 605), frontotemporal dementia (n = 409) and Parkinson’s disease dementia (n = 405). Multivariate logistic regression analysis was performed to investigate the association between use of cardiovascular medication and dementia disorders, after adjustment for age, gender, living alone, cognitive status and total number of drugs (a proxy for overall co-morbidity). Results Seventy percent of all the dementia patients used cardiovascular medication. Use of cardiovascular drugs is common in patients with vascular and mixed dementia. Male gender, higher age, slightly better cognitive status and living with another person was associated with use of cardiovascular medication. Conclusions Cardiovascular medication is used extensively across dementia disorders and particularly in vascular and mixed dementia. Future research should investigate the tolerability and effectiveness of these drugs in the different dementia disorders.
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Affiliation(s)
- Pavla Cermakova
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; International Clinical Research Center and St.Anne's University Hospital, Pekařská 53, 656 91 Brno, Czech Republic
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden
| | - Kristina Johnell
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Aging Research Center, Karolinska Institutet and Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, 141 57 Huddinge, Sweden ; Department of Geriatric Medicine, Karolinska University Hospital, 141 86 Huddinge, Sweden
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