Purpose: Due to the use of multiple drugs and prevalence of diminished cognitive function, community-dwelling elderly individuals are more likely to have drug-related issues. We examined changes in quality of life (QOL) and activities of daily living (ADL) 3 months and 6 months after reducing drug use of dementia patients who had newly begun community-dwelling care.  Methods: Prescription drug use was reduced in the intervention group, whereas the non-intervention group continued their regimen or began using additional drugs. QOL and ADL were assessed with the Japanese version of the EQ-5D and the Barthel Index, respectively.  Results: Subjects were 32 individuals aged ≥65 years who had begun community-dwelling between March and July 2014 and had received approval for long-term care insurance. On average, the intervention group (n = 19) stopped using 2.6 prescription drugs. After 6 months, the differences in the QOL and ADL scores in the intervention group were -0.03 ± 0.29 and 6.32 ± 18.6, respectively, while the differences in the QOL and ADL scores in the non-intervention group (n = 13) were -0.13 ± 0.29 and -2.69 ± 23.7, respectively. In the intervention group, ADL scores were significantly increased by 14.0 ± 11.1 6 months after reduced benzodiazepine use.  Conclusions: QOL was maintained with reduced drug use, while ADL score was slightly increased. In addition, the reduction of benzodiazepine use significantly increased ADL. In order to reduce polypharmacy among community-dwelling elderly patients, it is necessary to create an opportunity for pharmacists to re-examine their prescriptions This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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<b><i>Aims:</i></b> As the number of older people with dementia increases, safe pharmacotherapy in this population has attracted attention in recent years. The aims of this study were to clarify the prescribing patterns in older patients who were prescribed anti-dementia drugs and to investigate the association of potentially inappropriate medications (PIMs) with the use of anti-dementia drugs. <b><i>Methods:</i></b> Adults aged ≥65 years, who were prescribed anti-dementia drugs at 585 pharmacies across Japan (<i>N</i> = 7,953), were surveyed. The percentage of prescriptions of anti-dementia drugs and the effect of those prescriptions on PIMs were investigated. <b><i>Results:</i></b> Prescriptions of anti-dementia drugs were found in 4.4% of the entire study population. A multiple logistic regression analysis revealed that the use of anti-dementia drugs reduced the risk of prescribing psychotropic drugs, which represented PIMs, and that a combination of anti-dementia drugs (e.g., cholineesterase inhibitor with memantine) may reduce the risk of prescribing PIMs compared with monotherapy. <b><i>Conclusion:</i></b> The use of anti-dementia drugs was associated with fewer prescriptions of drugs considered as PIMs.

Background: Patients with dementia may have already progressed to an advanced stage of illness before they receive a proper diagnosis in a medical institution. Early detection of dementia is critical, and simplified screening methods are needed to support this goal.Methods: An easy-to-complete questionnaire, consisting of 15 items that assess behaviors associated with dementia, was used for this study. Respondents were asked to fill out both the questionnaire and the Hasegawa Dementia Rating Scale-Revised (HDS-R). Multivariate regression analyses were used to identify which of the 15 items were significantly related to the HDS-R. Original Articles -83 -Results: The response rate was 74% (217/293). Using multivariate logistic regression, 4 items from the questionnaire were identified as predictors of an HDS-R score¯20 ("Needs to be diagnosed"). These items include: "Cannot perform multiple tasks at the same time", "Unable to count money", "Unable to choose one's seasonal clothes", and "Repeatedly buying the same thing" (all ps < 0.05). Age and gender were also significant predictors in the model. A revised questionnaire based on these results combines the 6 significant predictors; sensitivity and specificity were 93.9% and 82.1%, respectively.Conclusions: This work developed a simplified screening method for dementia that can be implemented in primary care settings.

ObjectiveThe pharmacological effects of generic (GE) donepezil are the same as Aricept, its brand-name counterpart. However, little is known as to whether these two drugs provide the same quality of life (QOL). The study subjects were patients with Alzheimer’s disease who were taking donepezil hydrochloride tablets, and were selected by visiting either the local pharmacies or the patients’ homes. We chose the brand-name drug Aricept and its GE form donepezil to investigate, from a long-term caregiver’s perspective, the influence of both drugs on the patients’ QOL.MethodsAn EuroQol-5 Dimension (EQ-5D) was used to assess the QOL of patients with Alzheimer’s disease, before and after various Aricept and/or donepezil regimens. Patients were divided into four groups: first time users of Aricept (n=43), first time users of GE donepezil (n=45), users refilling previous prescriptions of Aricept (n=51), and users switching from Aricept to GE donepezil (n=51).ResultsThe average change in the EQ-5D utility indices rose significantly in the patients starting a new regimen of Aricept and its GE drug. The patients continuing an existing regimen of Aricept showed no significant differences, even after Aricept was switched to a GE drug.ConclusionThe QOL of patients starting a new regimen of Aricept and its GE drug improved. The QOL was maintained upon switching to the GE drug form.

Table S1. Characteristics of participants by stair climbing. Table S2. The association between stair climbing and mortality risk among men.Table S3. The association between stair climbing and mortality risk among women.

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