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Potentially inappropriate medications that impact cognition are common in older adults with Alzheimer’s disease or related dementias, driven by antipsychotics
Author(s) -
Vickers Lauren,
Martinez Ashley I,
Wallem Alexandra M,
Moga Daniela C
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.046681
Subject(s) - medicine , dementia , polypharmacy , logistic regression , confounding , psychiatry , disease , population , gerontology , environmental health
Background Older adults with dementia are particularly vulnerable to adverse effects of potentially inappropriate medication (PIM) use. The Beers Criteria identifies PIMs, including antipsychotics, benzodiazepines (BZD), and non‐benzodiazepine benzodiazepine receptor agonist hypnotics (Z drugs) that are linked to cognitive impairment or decline (“Cog‐PIMs”). This study investigated the difference in Cog‐PIM use as reported for patients with and without Alzheimer’s disease or related dementias (ADRD) in a nationally representative sample of the United States population. Methods We conducted a cross‐sectional study using the 2016 National Ambulatory Medical Care Survey. The analysis included non‐perioperative office‐based visits for patients ≥ 65 years old. Visit characteristics were compared between those with and without ADRD using descriptive statistics, and adjusted logistic regression was used to identify predictors of Cog‐PIM use. Results Of the 218,182,131 outpatient visits, 2.2% were for patients with ADRD (N=4,651,563). Approximately twice as many visits with Cog‐PIM reports were among those with ADRD compared to those without (22.9 vs 10.7%), after adjusting for known confounders, ADRD was not a significant predictor of Cog‐PIM report (OR [95% CI] 1.2 [0.4‐3.3]). This is likely because there were no differences between groups in report of BZDs (8.7 vs 8.8%) and Z drugs (2.2 vs 1.9%). The most striking difference in Cog‐PIM report between those with and without ADRD occurred with antipsychotics, which were noted in 15.5% vs 0.8% of visits; the most common included quetiapine (40.0%), haloperidol (26.2%), and olanzapine (20.3%). After adjusting for potential confounders, ADRD was a significant predictor of antipsychotic report (aOR [95% CI] 34.9 [8.7‐141.1]). Hispanic ethnicity and report of >5 medications were also significantly associated with antipsychotic use (4.3 [1.4‐13.4] and 6.3 [1.9‐20.7] respectively). Conclusion In a nationally representative sample, Cog‐PIM use was reported in nearly one‐quarter of visits for patients with ADRD, driven by report of an antipsychotic. Presence of ADRD was a significant predictor of visits reporting an antipsychotic, and both traditional and atypical antipsychotics were highly prevalent. Given that these medications are not recommended for older adults and that they may negatively impact cognition, future work should investigate points of intervention to reduce Cog‐PIM use (specifically antipsychotics) in the ADRD population.