Psychotropic drug use and psychotropic polypharmacy among persons with Alzheimer's disease

Kim Orsel; Heidi Taipale; Anna-Maija Tolppanen; Marjaana Koponen; Antti Tanskanen; Jari Tiihonen; Helga Gardarsdottir; Sirpa Hartikainen

doi:10.1002/pds.4629

Abstract

Background: Psychotropic drugs are frequently used for the treatment of behavioural and psychological symptoms of dementia in persons with Alzheimer's disease (AD). Evidence for benefits are limited and concerns have been raised about the safety, especially for the concomitant use of multiple psychotropic drugs. Objectives: The objective of this study was to investigate prevalence of psychotropic drug and psychotropic polypharmacy (PPP) use and associations with PPP among persons with and without AD, from 5 years before until 4 years after AD diagnosis at time points every 6 months. Methods: The study was a part of the nationwide MEDALZ study, including all community-dwelling persons who received a clinically verified diagnosis of AD between 2005 and 2011 in Finland (n = 70 719). Drug exposure was modelled with PRE2DUP method based on purchases recorded in the prescription register (1995-2015). Point prevalence of antipsychotic, antidepressant and benzodiazepine, and related drug use was measured at 6 months time intervals, beginning 5 years before AD diagnoses and until 4 years after. Factors associated with PPP (use of 2 or more psychotropic drugs) were investigated with logistic regression. Results: The prevalence of psychotropic drug use, especially use of antipsychotics and antidepressants, increased during the course of AD. The use of 2 or more psychotropic drugs increased from 5.9% 5 years before to 18.3% 4 years after AD diagnosis. The most frequently used combination was antipsychotics and antidepressants. Predictors for PPP were younger age (less than 75 years), female sex, and history of psychiatric disease. The use of acetylcholinesterase inhibitors was inversely associated with PPP. Four years after AD diagnosis, almost 50% of persons with AD used at least one psychotropic drug. Conclusions: The high prevalence of psychotropic polypharmacy is concerning because of possible higher risks for adverse effects and events.

Original language	English
Pages	294
Number of pages	1
DOIs	https://doi.org/10.1002/pds.4629
Publication status	Published - 1 Aug 2018
Event	34th International conference on Pharmacoepidemiology & Therapeutic Risk Management - Prague Congress Centre, Prague, Czech Republic Duration: 22 Aug 2018 → 26 Aug 2018

Conference

Conference	34th International conference on Pharmacoepidemiology & Therapeutic Risk Management
Country/Territory	Czech Republic
City	Prague
Period	22/08/18 → 26/08/18

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

antidepressant agent
benzodiazepine
cholinesterase inhibitor
endogenous compound
neuroleptic agent
adult
adverse event
Alzheimer disease
community dwelling person
conference abstract
controlled study
diagnosis
drug combination
drug exposure
drug therapy
female
Finland
human
major clinical study
multicenter study
polypharmacy
prescription
prevalence
psychosis

Access to Document

10.1002/pds.4629

Cite this

Orsel, K., Taipale, H., Tolppanen, A.-M., Koponen, M., Tanskanen, A., Tiihonen, J., Gardarsdottir, H., & Hartikainen, S. (2018). Psychotropic drug use and psychotropic polypharmacy among persons with Alzheimer's disease. 294. Abstract from 34th International conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic. https://doi.org/10.1002/pds.4629

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title = "Psychotropic drug use and psychotropic polypharmacy among persons with Alzheimer's disease",

abstract = "Background: Psychotropic drugs are frequently used for the treatment of behavioural and psychological symptoms of dementia in persons with Alzheimer's disease (AD). Evidence for benefits are limited and concerns have been raised about the safety, especially for the concomitant use of multiple psychotropic drugs. Objectives: The objective of this study was to investigate prevalence of psychotropic drug and psychotropic polypharmacy (PPP) use and associations with PPP among persons with and without AD, from 5 years before until 4 years after AD diagnosis at time points every 6 months. Methods: The study was a part of the nationwide MEDALZ study, including all community-dwelling persons who received a clinically verified diagnosis of AD between 2005 and 2011 in Finland (n = 70 719). Drug exposure was modelled with PRE2DUP method based on purchases recorded in the prescription register (1995-2015). Point prevalence of antipsychotic, antidepressant and benzodiazepine, and related drug use was measured at 6 months time intervals, beginning 5 years before AD diagnoses and until 4 years after. Factors associated with PPP (use of 2 or more psychotropic drugs) were investigated with logistic regression. Results: The prevalence of psychotropic drug use, especially use of antipsychotics and antidepressants, increased during the course of AD. The use of 2 or more psychotropic drugs increased from 5.9\% 5 years before to 18.3\% 4 years after AD diagnosis. The most frequently used combination was antipsychotics and antidepressants. Predictors for PPP were younger age (less than 75 years), female sex, and history of psychiatric disease. The use of acetylcholinesterase inhibitors was inversely associated with PPP. Four years after AD diagnosis, almost 50\% of persons with AD used at least one psychotropic drug. Conclusions: The high prevalence of psychotropic polypharmacy is concerning because of possible higher risks for adverse effects and events.",

keywords = "antidepressant agent, benzodiazepine, cholinesterase inhibitor, endogenous compound, neuroleptic agent, adult, adverse event, Alzheimer disease, community dwelling person, conference abstract, controlled study, diagnosis, drug combination, drug exposure, drug therapy, female, Finland, human, major clinical study, multicenter study, polypharmacy, prescription, prevalence, psychosis",

author = "Kim Orsel and Heidi Taipale and Anna-Maija Tolppanen and Marjaana Koponen and Antti Tanskanen and Jari Tiihonen and Helga Gardarsdottir and Sirpa Hartikainen",

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month = aug,

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doi = "10.1002/pds.4629",

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Orsel, K, Taipale, H, Tolppanen, A-M, Koponen, M, Tanskanen, A, Tiihonen, J, Gardarsdottir, H & Hartikainen, S 2018, 'Psychotropic drug use and psychotropic polypharmacy among persons with Alzheimer's disease', 34th International conference on Pharmacoepidemiology & Therapeutic Risk Management, Prague, Czech Republic, 22/08/18 - 26/08/18 pp. 294. https://doi.org/10.1002/pds.4629

TY - CONF

T1 - Psychotropic drug use and psychotropic polypharmacy among persons with Alzheimer's disease

AU - Orsel, Kim

AU - Taipale, Heidi

AU - Tolppanen, Anna-Maija

AU - Koponen, Marjaana

AU - Tanskanen, Antti

AU - Tiihonen, Jari

AU - Gardarsdottir, Helga

AU - Hartikainen, Sirpa

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Psychotropic drugs are frequently used for the treatment of behavioural and psychological symptoms of dementia in persons with Alzheimer's disease (AD). Evidence for benefits are limited and concerns have been raised about the safety, especially for the concomitant use of multiple psychotropic drugs. Objectives: The objective of this study was to investigate prevalence of psychotropic drug and psychotropic polypharmacy (PPP) use and associations with PPP among persons with and without AD, from 5 years before until 4 years after AD diagnosis at time points every 6 months. Methods: The study was a part of the nationwide MEDALZ study, including all community-dwelling persons who received a clinically verified diagnosis of AD between 2005 and 2011 in Finland (n = 70 719). Drug exposure was modelled with PRE2DUP method based on purchases recorded in the prescription register (1995-2015). Point prevalence of antipsychotic, antidepressant and benzodiazepine, and related drug use was measured at 6 months time intervals, beginning 5 years before AD diagnoses and until 4 years after. Factors associated with PPP (use of 2 or more psychotropic drugs) were investigated with logistic regression. Results: The prevalence of psychotropic drug use, especially use of antipsychotics and antidepressants, increased during the course of AD. The use of 2 or more psychotropic drugs increased from 5.9% 5 years before to 18.3% 4 years after AD diagnosis. The most frequently used combination was antipsychotics and antidepressants. Predictors for PPP were younger age (less than 75 years), female sex, and history of psychiatric disease. The use of acetylcholinesterase inhibitors was inversely associated with PPP. Four years after AD diagnosis, almost 50% of persons with AD used at least one psychotropic drug. Conclusions: The high prevalence of psychotropic polypharmacy is concerning because of possible higher risks for adverse effects and events.

AB - Background: Psychotropic drugs are frequently used for the treatment of behavioural and psychological symptoms of dementia in persons with Alzheimer's disease (AD). Evidence for benefits are limited and concerns have been raised about the safety, especially for the concomitant use of multiple psychotropic drugs. Objectives: The objective of this study was to investigate prevalence of psychotropic drug and psychotropic polypharmacy (PPP) use and associations with PPP among persons with and without AD, from 5 years before until 4 years after AD diagnosis at time points every 6 months. Methods: The study was a part of the nationwide MEDALZ study, including all community-dwelling persons who received a clinically verified diagnosis of AD between 2005 and 2011 in Finland (n = 70 719). Drug exposure was modelled with PRE2DUP method based on purchases recorded in the prescription register (1995-2015). Point prevalence of antipsychotic, antidepressant and benzodiazepine, and related drug use was measured at 6 months time intervals, beginning 5 years before AD diagnoses and until 4 years after. Factors associated with PPP (use of 2 or more psychotropic drugs) were investigated with logistic regression. Results: The prevalence of psychotropic drug use, especially use of antipsychotics and antidepressants, increased during the course of AD. The use of 2 or more psychotropic drugs increased from 5.9% 5 years before to 18.3% 4 years after AD diagnosis. The most frequently used combination was antipsychotics and antidepressants. Predictors for PPP were younger age (less than 75 years), female sex, and history of psychiatric disease. The use of acetylcholinesterase inhibitors was inversely associated with PPP. Four years after AD diagnosis, almost 50% of persons with AD used at least one psychotropic drug. Conclusions: The high prevalence of psychotropic polypharmacy is concerning because of possible higher risks for adverse effects and events.

KW - antidepressant agent

KW - benzodiazepine

KW - cholinesterase inhibitor

KW - endogenous compound

KW - neuroleptic agent

KW - adult

KW - adverse event

KW - Alzheimer disease

KW - community dwelling person

KW - conference abstract

KW - controlled study

KW - diagnosis

KW - drug combination

KW - drug exposure

KW - drug therapy

KW - female

KW - Finland

KW - human

KW - major clinical study

KW - multicenter study

KW - polypharmacy

KW - prescription

KW - prevalence

KW - psychosis

U2 - 10.1002/pds.4629

DO - 10.1002/pds.4629

M3 - Abstract

SP - 294

T2 - 34th International conference on Pharmacoepidemiology & Therapeutic Risk Management

Y2 - 22 August 2018 through 26 August 2018

ER -