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P2‐293: TIME TRENDS IN PSYCHOTROPIC DRUG USE IN PATIENTS WITH DEMENTIA: A NATIONWIDE STUDY
Author(s) -
Nørgaard Ane,
JensenDahm Christina,
Gasse Christiane,
Aastrup Aske,
Waldemar Gunhild
Publication year - 2014
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.2014.05.971
Subject(s) - dementia , medicine , antipsychotic , psychiatry , anxiolytic , population , psychotropic drug , antidepressant , drug , schizophrenia (object oriented programming) , anxiety , disease , environmental health
Background: The role of brain pathology in declining physical function prior to death is virtually unknown. We sought to determine associations between neuropathological changes associated with Alzheimer’s disease (AD) and brain vascular disease (BVD) with physical function measured at study visits. Methods: We studied measured trajectories of physical function prior to death in 331 ACT participants who died and were autopsied. The ACT study enrolled 3842 randomly selected Group Health members aged 65 and older from 1994-2012 whowere initially free of dementia and had at least 2 measurements of the Short Physical Performance Battery (SPPB) prior to 2012. We used linear mixed effects models for SPPB data, yielding subject-specific slopes, intercepts (at death), and predicted SPPB levels 5 years prior to death. We defined AD neuropathology on the basis of neurofibrillary tangles classified using Braak and Braak criteria, neuritic plaques using CERAD staging, and severity of amyloid angiopathy. We defined BVD neuropathology on the basis of macroscopic infarcts, cerebral infarcts, and atherosclerosis. We used modified Poisson regression models to estimate relative risks (RR) and 95% confidence intervals (CI) with bootstrap sampling. We used inverse probability weights to account for selection factors related to being in the autopsy cohort. Results: Risks of AD-type pathology, both CERAD plaque and Braak tangle scores, were significantly lower for individuals with faster rates of SPPB decline (see Table). Risks of BVD pathology were non-significantly increased for participants with faster rates of SPPB declines, especially for cystic infarcts. Both AD and BVD pathologies were associated with poorer predicted SPPB scores 5 years prior to death, with the strongest relative risks observed for cystic infarcts (p<0.01). Conclusions: People with either AD or BVD neuropathology had lower physical performance 5 years prior to death than people without neuropathology. People with AD neuropathology had less subsequent decline in SPPB prior to death, while people with BVD had faster declines in physical performance. These results support a role for brain neuropathology in declining physical performance prior to death.