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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

Published online by Cambridge University Press:  19 June 2017

Soili Törmälehto ,
Janne Martikainen ,
J. Simon Bell ,
Ilona Hallikainen  and
Anne M. Koivisto
Soili Törmälehto*
Affiliation:
Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
Janne Martikainen
Affiliation:
Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland
J. Simon Bell
Affiliation:
Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
Ilona Hallikainen
Affiliation:
Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
Anne M. Koivisto
Affiliation:
Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland
*
Correspondence should be addressed to: Soili Törmälehto, University of Eastern Finland, Faculty of Health Sciences, School of Pharmacy, POB 1627, FI-70211 Kuopio, Finland. Phone: +358 40 757 4695. Email: soili.tormalehto@uef.fi.
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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.

Keywords

activities of daily living (ADLs)Alzheimer's disease (AD)antipsychoticscognitive impairmentneuropsychiatric symptoms

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 10 , October 2017 , pp. 1723 - 1733
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.Google Scholar
Beeri, M. S., Werner, P., Davidson, M. and Noy, S. (2002). The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling Alzheimer's disease patients. International Journal of Geriatric Psychiatry, 17, 403–408.Google Scholar
Brodaty, H., Connors, M. H., Xu, J., Woodward, M. and Ames, D. (2015). The course of neuropsychiatric symptoms in dementia: a 3-year longitudinal study. Journal of the American Medical Directors Association, 16, 380–387. doi:10.1016/j.jamda.2014.12.018.Google Scholar
Calvó-Perxas, L. et al. (2012). Central nervous system drug consumption depending on the time between symptom onset and the diagnosis of Alzheimer's disease: an analysis by the registry of dementias of Girona. Dementia and Geriatric Cognitive Disorders, 33, 104–110. doi:10.1159/000337340.Google Scholar
Chandler, M. J. et al. (2005). A total score for the CERAD Neuropsychological Battery. Neurology, 65, 102–106.CrossRefGoogle ScholarPubMed
Clark, C. M. et al. (1999). Variability in annual mini-mental state examination score in patients with probable Alzheimer disease: a clinical perspective of data from the consortium to establish a registry for Alzheimer's disease. Archives of Neurology, 56, 857–862.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
de Oliveira, F. F., Bertolucci, P. H., Chen, E. S. and Smith Mde, A. (2014). Pharmacological modulation of cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease. Journal of the Neurological Sciences, 336, 103–108. doi:10.1016/j.jns.2013.10.015.CrossRefGoogle ScholarPubMed
Dillon, C., Serrano, C. M., Castro, D., Leguizamón, P. P., Heisecke, S. L. and Taragano, F. E. (2013). Behavioral symptoms related to cognitive impairment. Neuropsychiatric Disease and Treatment, 9, 1443–1455. doi:10.2147/NDT.S47133.Google Scholar
Ellul, J. et al. (2007). The effects of commonly prescribed drugs in patients with Alzheimer's disease on the rate of deterioration. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 233–239.Google Scholar
Fereshtehnejad, S. M., Johnell, K. and Eriksdotter, M. (2014). Anti-dementia drugs and co-medication among patients with Alzheimer's disease: investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem). Drugs & Aging, 31, 215–224. doi: 10.1007/s40266-014-0154-8.Google Scholar
Finnish Medical Society Duodecim. (2010). Current Care: Memory Disorders (in Finnish with English Summary). Helsinki: Finnish Medical Society Duodecim. Available at: http://www.kaypahoito.fi; last accessed 16 August 2015.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Galasko, D. et al. (1997). An inventory to assess activities of daily living for clinical trials in Alzheimer's disease. The Alzheimer's disease cooperative study. Alzheimer Disease and Associated Disorders, 11 (Suppl. 2), S33–S39.Google Scholar
Hallikainen, I. et al. (2012). Cognitive and neuropsychiatric symptom differences in early stages of Alzheimer's disease: Kuopio ALSOVA study. Dementia and Geriatric Cognitive Disorders Extra, 2, 209–218. doi:10.1159/000338231.Google Scholar
Hallikainen, I. et al. (2013). Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study. International Psychogeriatrics, 25, 1335–1344. doi:10.1017/S1041610213000653.CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. The British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Jönsson, L. et al. (2006). Determinants of costs of care for patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 449–459.Google Scholar
Kales, H. C., Gitlin, L. N. and Lyketsos, C. G. (2015). Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 350, h369. doi:10.1136/bmj.h369.Google Scholar
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. International Journal of Geriatric Psychiatry, 26, 473–482. doi:10.1002/gps.2550.Google Scholar
Koponen, M. et al. (2015). Long-term use of antipsychotics among community-dwelling persons with Alzheimer's disease: a nationwide register-based study. European Neuropsychopharmacology, 25, 1706–1713. doi:10.1016/j.euroneuro.2015.07.008.Google Scholar
Lyketsos, C. G. et al. (2011). Neuropsychiatric symptoms in Alzheimer's disease. Alzheimer's and Dementia, 7, 532–539. doi:10.1016/j.jalz.2011.05.2410.Google Scholar
Martinez, C., Jones, R. W. and Rietbrock, S. (2013). Trends in the prevalence of antipsychotic drug use among patients with Alzheimer's disease and other dementias including those treated with antidementia drugs in the community in the UK: a cohort study. BMJ Open, 3, e002080. doi:10.1136/bmjopen-2012-002080.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939–944.Google Scholar
McLaughlin, T. et al. (2010). Dependence as a unifying construct in defining Alzheimer's disease severity. Alzheimer's and Dementia, 6, 482–493. doi:10.1016/j.jalz.2009.09.004.Google Scholar
Mega, M. S., Cummings, J. L., Fiorello, T. and Gornbein, J. (1996). The spectrum of behavioral changes in Alzheimer's disease. Neurology, 46, 130–135.Google Scholar
Morris, J. C. (1993). The clinical dementia rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.Google Scholar
Rocca, P., Marino, F., Montemagni, C., Perrone, D. and Bogetto, F. (2007). Risperidone, olanzapine and quetiapine in the treatment of behavioral and psychological symptoms in patients with Alzheimer's disease: preliminary findings from a naturalistic, retrospective study. Psychiatry and Clinical Neurosciences, 61, 622–629.Google Scholar
Rosenberg, P. B. et al. (2012). The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease. International Journal of Geriatric Psychiatry, 27, 1248–1257. doi:10.1002/gps.3769.Google Scholar
Schneider, L. S., Dagerman, K. and Insel, P. S. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. The American Journal of Geriatric Psychiatry, 14, 191–210.Google Scholar
Taipale, H., Koponen, M., Tanskanen, A., Tolppanen, A. M., Tiihonen, J. and Hartikainen, S. (2014). High prevalence of psychotropic drug use among persons with and without Alzheimer's disease in Finnish nationwide cohort. European Neuropsychopharmacology, 24, 1729– 1737.Google Scholar
Törmälehto, S. M. et al. (2015). Use of anti-dementia drugs in relation to change in cognition, behavior, and functioning in Alzheimer's disease over a three-year period: Kuopio ALSOVA study. Journal of Alzheimer's Disease, 48, 1033–1041. doi: 10.3233/JAD-150092.Google Scholar
Vigen, C. L. et al. (2011). Cognitive effects of atypical antipsychotic medications in patients with Alzheimer's disease: outcomes from CATIE-AD. The American Journal of Psychiatry, 168, 831–839. doi:10.1176/appi.ajp.2011.08121844.Google Scholar
Williams, M. M., Storandt, M., Roe, C. M. and Morris, J. C. (2013). Progression of Alzheimer's disease as measured by clinical dementia rating sum of boxes scores. Alzheimer's and Dementia, 9 (Suppl. 1), S39–S44. doi:10.1016/j.jalz.2012.01.005.Google Scholar
Zhu, C. W. et al. (2010). Longitudinal medication usage in Alzheimer disease patients. Alzheimer Disease and Associated Disorders, 24, 354–359. doi: 10.1097/WAD.0b013e3181e6a17a.Google Scholar
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