Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India

Abstract

Background:Dementia is one of the most disabling disorders afflicting the elderly, with a staggering emotional and economic impact. Antidementia agents have been used for delaying cognitive decline. Antipsychotics are commonly prescribed for behavioral symptoms associated with dementia.Objectives:To explore the use of anti-dementing agents and antipsychotics used in patients with a diagnosis of dementiaMaterials and Methods:A retrospective chart review method; geriatric clinic of tertiary care setting.Results:The study sample included 51 consecutive patients with a diagnosis of dementia. The commonest subtype of dementia that was diagnosed was Alzheimer's disease (45%), followed by Frontotemporal dementia (25%).The commonest antidementia drug that was used was donepezil, which alone was prescribed in 27 patients (52%). The commonest antipsychotic used was quetiapine, which was used in 24 patients (47%).Conclusions:The study found donepezil to be the most commonly prescribed antidementia drug and quetiapine to be the most commonly used antipsychotic in a tertiary care geriatric clinic, in a developing country. There is a need to study the cost-effectiveness of antidementia and antipsychotic drugs in patients with dementia, in developing countries.

Drug Utilization Pattern in Patients with Different Types of Dementia in Western India

“…In study reported by Prasad et al [6] likewise the commonest antipsychotic used was Quetiapine, which was used in 24 patients (47%) in a dose range of 25 to 300 mg/day. The drug might be a choice since it has lesser propensity of causing extrapyramidal side effects as compared to the other antipsychotic drugs.…”

“…An audit involving Indian geriatric population which was performed by Prasad et al on clinical practice of medications in dementia, his analysis concluded that the commonest antidementia drug used and alone prescribed was Donepezil (52%), while Rivastigmine alone was used in a single patient, Memantine alone was prescribed in 18% of cases, Galantamine alone was used in three patients only, whereas, Rivastigmine in six patients. A total of 12% were not prescribed any anti-dementia drug [ 6 ]. In another study conducted by Rungsanpanya et al wherein analysis of 91 prescriptions of Dementia patients, reported that Donepezil was the most frequently prescribed drug (70%), followed by Rivastigmine (22.5%) [ 18 ].…”

“…Our study found that Quetiapine, an atypical antipsychotic, was the most common antipsychotic used for behavioral and psychotic symptoms in 38.46% of cases in a dose range of 25 mg to 100 mg per day. In study reported by Prasad et al [ 6 ] likewise the commonest antipsychotic used was Quetiapine, which was used in 24 patients (47%) in a dose range of 25 to 300 mg/day. The drug might be a choice since it has lesser propensity of causing extrapyramidal side effects as compared to the other antipsychotic drugs.…”

“…Published Indian literature [ 6 ] on various drugs used in dementia in India as well as in Gujarat (a part of western India) is still in its infancy. The prescription pattern of antidementia drugs and use of antipsychotics, vitamin B12, and folic acid has still not much been studied in developing countries.…”

Indian research on acute organic brain syndrome: Delirium

“…Prasad et al . in their original research article “Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India”[ 4 ] found donepezil to be the most commonly prescribed antidementia drug and quetiapine to be the most commonly used antipsychotic in a tertiary care geriatric clinic, in a developing country. Behavioral and psychological symptoms of dementia (BPSD), are an integral part of the dementia syndrome but the management of BPSD requires clarification of target symptoms, ruling out delirium and comorbid major psychiatric diagnoses, and creatively addressing possible social, environmental, or behavioral remedies along with pharmacotherapy.…”