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P3‐458: Patient specific prescriber education and feedback is effective in reducing use of antipsychotics in the elderly
Author(s) -
Woodward Michael,
Roughead Elizabeth,
Gilbert Andrew,
Kalisch Lisa
Publication year - 2010
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 - 10.1016/j.jalz.2010.05.2001
Subject(s) - medicine , risperidone , veterans affairs , antipsychotic , psychiatry , medical prescription , intervention (counseling) , randomized controlled trial , dementia , adverse effect , population , family medicine , schizophrenia (object oriented programming) , nursing , disease , environmental health
(MMSE), Clinical Dementia Rating (CDR) scale, and Functional Activities Questionnaire (FAQ) Results: 44.0% of 402 MCI patients and 84.6% of 188 mild AD patients were treated with cholinesterase inhibitors; and 11.4% of MCI patients and 45.7% of AD patients were treated with memantine at entry. MCI patients who received cholinesterase inhibitors with or without memantine declined further and converted to dementia sooner than patients who did not receive cholinesterase inhibitors. AD patients who received cholinesterase inhibitors and memantine used cholinesterase inhibitors longer, were more functionally impaired, and declined more on the MMSE and CDR (but not the ADAS-cog or FAQ) than those who received only cholinesterase inhibitors. Conclusions: Results from this observational study are consistent with hypotheses that physicians prescribe cholinesterase inhibitors and memantine earlier than indicated in the FDA-approved labeling to patients who are relatively more severe or rapidly progressing; and that longterm treatment started earlier than indicated is associated with clinical decline. The use of cholinesterase inhibitors and memantine will likely affect the interpretation of outcomes and biomarkers in MCI and early AD clinical trials.