Exposure to psychotropics in the French older population living with dementia: a nationwide population‐based study

Breining, Alice; Bonnet-Zamponi, Dominique; Zerah, Lorène; Micheneau, Carole; Riolacci-Dhoyen, N; Chan-Chee, Christine; Deligne, Jean; Harlin, Jean-Marc; Boddaert, Jacques; Verny, Marc; Leperre-Desplanques, Armelle

doi:10.1002/gps.4517

Cited by 23 publications

(17 citation statements)

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“…Breining et al . reported that older patients with dementia utilized antipsychotics and antidepressants more frequently than healthy participants did in an age‐matched population. Tosto et al .…”

Section: Discussionmentioning

confidence: 99%

Diabetes mellitus and risk of early‐onset Alzheimer's disease: a population‐based case–control study

Kadohara

Sato

Kawakami

2017

Euro J of Neurology

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Section: Discussionmentioning

confidence: 99%

Diabetes mellitus and risk of early‐onset Alzheimer's disease: a population‐based case–control study

Kadohara

Sato

Kawakami

2017

Euro J of Neurology

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“…Thus, the adjusted OR for dementia was reduced in patients using tricyclic agents, but use of other classes such as SSRIs and other antidepressants was associated with an increased risk of dementia. A separate prospective, nationwide, population-based cohort study in France78 suggests exposure to psychotropics was higher in patients with dementia, but neither of these two population-based studies actually prove causality.…”

Section: Current Approaches To Manage Visceral Pain In Patients With Ibsmentioning

confidence: 96%

Dietary and pharmacological treatment of abdominal pain in IBS

Camilleri

Boeckxstaens

2017

Gut

121

122

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This review introduces the principles of visceral sensation and appraises the current approaches to management of visceral pain in functional GI diseases, principally IBS. These approaches include dietary measures including fibre supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, and pharmacological approaches such as antispasmodics, peppermint oil, antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), 5-HT receptor antagonists (alosetron, ondansetron, ramosetron), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-opioid receptor (OR) and κ-OR agonist, δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant) and GABAergic agents (gabapentin and pregabalin). Efficacy and safety are discussed based on pivotal trials or published systematic reviews and meta-analysis, expressing ORs or relative risks and their 95% CIs. Potential new approaches may be based on recent insights on mucosal expression of genes, and microRNA and epigenetic markers in human biopsies and in animal models of visceral hypersensitivity.The objectives of this review are to appraise the physiology and anatomy of gut sensation and the efficacy in the relief of visceral pain (typically in IBS) of several classes of therapies. These include fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and different classes of medications (box 1). Box 1Classes of pharmacological agents for visceral painAntidepressants (tricyclic agents, selective serotonin reuptake inhibitors)Peppermint oil5-HT receptor antagonists (alosetron, ondansetron, ramosetron)Non-absorbed antibiotic (rifaximin)Secretagogues (lubiprostone, linaclotide)μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline)Histamine H1 receptor antagonist (ebastine)Neurokinin-2 receptor antagonist (ibodutant)GABAergic agents (gabapentin and pregabalin).

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“…A percentage of antidepressants in this population might have been prescribed for neuropathic pain. A high rate of use of antidepressants has been described also in other European countries [51][52][53][54][55]. This aspect has a fundamental importance because, despite the potential of antidepressants for neurogenesis [56,57], the use of drugs endowed with anticholinergic burden can worsen cognitive decline, increase the risk of falls, institutionalization, and mortality [58][59][60][61][62][63][64][65].…”

Section: Discussionmentioning

confidence: 99%

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

Scuteri

Vulnera²,

Piro³

et al. 2020

Eur J Clin Pharmacol

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Purpose Data concerning the number of diagnoses and of the drugs prescribed to patients affected by dementia are still scarce. Here we test whether or not (1) prescription of symptomatic drugs against Alzheimer’s disease (AD) may approximate the number of patients affected by dementia in Italy and (2) adherence to this treatment affects the pattern of prescription of drugs (i.e. antipsychotics and antidepressants) for behavioural and psychological symptoms of dementia (BPSD) and the previously reported limited prescription of analgesics. Methods This retrospective observational study concerns 84,235 subjects older than 60 years and registered in the provincial prescription database of the health district of Cosenza accounting for a population of 298,000 inhabitants. The prescribing pattern of antipsychotics, antidepressants, and analgesics has been investigated in patients receiving concurrent prescriptions of acetylcholinesterase inhibitors (AChEI) and/or memantine. Data from a single centre for cognitive disturbances and dementia (CDCD) in the same health district were used to explore at which stage dementia was diagnosed. The study was approved by Calabria Region Ethical Committee no. 31/2017 and registered on October 31, 2017. Results The data show that 859 patients are treated with AChEI and/or memantine; 420 patients (48.89%) receive at least 80% of the recommended medications. CDCD data indicate a delay in dementia diagnosis, which often was made when the patients were moderately to severely demented (Mini Mental State Examination, MMSE ≤ 20). Adherence did not influence prescription of most of the drugs explored, but use of non-steroidal anti-inflammatory drugs was higher in non-adherent patients. Antipsychotics and antidepressants are frequently used (20.61–20.71% and 42.37–51.43%, respectively), and this, at least in part, might stem from the observed under-treatment of chronic pain (opioids are prescribed in the 4.76% and 12.46% of adherent and non-adherent patients and gabapentin and pregabalin are used in the 4.29% and 4.07% of adherent and non-adherent patients respectively), resulting in more frequent BPSD. 16.43% of patients receive antipsychotics for longer than 6–12 weeks. Conclusion This 2-year period study, including a wide cohort of community demented patients, shows that dementia is diagnosed late and that prevalence of BPSD prescriptions is high and not impacted by adherence to anti-dementia drugs. The rate of prescription of potentially harmful antipsychotics and antidepressants appears to be high though whether the concomitantly observed limited prescription of analgesics might be a contributing factor needs to be further investigated. Our data support the development of strategies to improve the management of BPSD.

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Exposure to psychotropics in the French older population living with dementia: a nationwide population‐based study

Abstract: This nationwide, population-based, drug-used study showed for the first time that older patients with dementia are chronically overexposed not only to antipsychotics but also to psychotropics.

Cited by 23 publications

References 50 publications

Diabetes mellitus and risk of early‐onset Alzheimer's disease: a population‐based case–control study

Diabetes mellitus and risk of early‐onset Alzheimer's disease: a population‐based case–control study

Dietary and pharmacological treatment of abdominal pain in IBS

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

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