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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: [email protected].
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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
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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