Medication‐related problems in older adults with and without preclinical Alzheimer’s disease: A baseline description from the INCREASE study

Background Older adults are susceptible to negative cognitive effects induced by inappropriate medication use. 1 Some individuals may accumulate amyloid‐ β deposits before symptomatic expression, suggesting preclinical Alzheimer’s disease (pAD). Inappropriate medication use may interact with this neuropathology to hasten symptomatic AD onset. Thus, we designed INCREASE: a randomized controlled trial (RCT) to improve medication use through targeted medication therapy management (tMTM) and ultimately delay AD symptomatic expression. 2Methods Community‐dwelling non‐demented adults ≥ 65 years old who regularly used ≥1 potentially inappropriate medication 3 were recruited for the RCT. Board certified geriatric pharmacists reviewed medication lists and identified medication‐related problems (MRPs) at baseline for all participants before conducting the tMTM intervention. Here, we describe this initial medication review, stratified by pAD status. pAD was defined as total brain relative standardized uptake values > 1.4 for PET amyloid. 3 Group differences were identified using Student’s t‐tests. Results 79 participants were included in this analysis (mean age 73.9 years [SD 5.9]; 66% female). 12.9 (4.9) baseline medication were reported on average, which did not differ significantly between participants with (14.2 [4.8]) and without (12.3 [5.1]) pAD. The most commonly reported medication classes were proton pump inhibitors, antihistamines, non‐steroidal anti‐inflammatory drugs, and vitamins/supplements. On average, 4.9 (SD 2.3) MRPs were identified per participant (389 MRPs total). The most common causes of MRPs were: 1) a medication not appropriate given the participants’ age and/or medical conditions; 2) dose/frequency too high; and 3) untreated medical condition. The most common recommendation by the pharmacist was to deprescribe the problem medication. There were no differences in the number or causes of MRPs based on pAD status. Conclusion Non‐demented older adults enrolled in an MTM RCT used more than ten medications concurrently, with about 5 MRPs identified in each participant. INCREASE will test the hypothesis that deprescribing these inappropriate medications may delay symptomatic AD. Given that the pharmacokinetics and pharmacodynamics of this population puts them at high risk for adverse drug events including cognitive impairment, future work should continue to optimize medication use to prevent cognitive decline. References: 1. Moga DC, et al. Trials . 2019;20(1):806. 2. Jack CR, et al. Brain . 2015;138(12):3747‐3759. 3. American Geriatrics Society. J Am Geriatr Soc . 2015;63(11):2227‐2246.