Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly

Löppönen, Minna; Räihä, Ismo; Isoaho, Raimo; Vahlberg, Tero; Puolijoki, Hannu; Kivelä, Sirkka‐Liisa

doi:10.1159/000093739

Cited by 19 publications

(19 citation statements)

References 75 publications

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“…Of the 13 articles three reported studies which were conducted in the USA [15,16], two each in the UK [17,18] and France [19,20] and one each in Brazil [21], Canada [22], Finland [23], Germany [24], Nigeria [25] and Norway [26]. …”

Section: Resultsmentioning

confidence: 99%

The treatment of hypertension in people with dementia: a systematic review of observational studies

2014

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BackgroundHypertension is very common in older people and a number of trials of antihypertensives have demonstrated benefit from treatment in even the oldest old. However, people with dementia were significantly under-represented in these studies and as a population are more likely to be physically frail, to suffer orthostatic hypotension and to experience adverse effects from polypharmacy at a lower drug count. It may be that different thresholds for commencement and cessation of treatment should be considered and may already be used for this group. Against this background this review sets out to describe the prevalence of hypertension in people with dementia, its treatment, change in treatment over time and the achievement of blood pressure (BP) control.MethodsThe PubMed, Cochrane, Embase and PsychINFO databases were searched for observational studies involving people with dementia and a diagnosis of hypertension. The search was limited to English language articles involving adults and humans published from 1990 onwards. Abstracts and titles were then reviewed with eligible articles read in full. Bibliographies were examined for further relevant studies. The final selection of studies was then analysed and appraised.ResultsThirteen articles were identified for analysis. The prevalence of hypertension in people with dementia was 45% (range 35%-84%). 73% of these were on at least one antihypertensive, with diuretics being the most common. The reported prevalence of hypertension in study populations remained unchanged over time. ACEi/ARBs and calcium channel blockers were prescribed more frequently in more recent studies whilst use of β-blockers and diuretics remained unchanged. Target blood pressure was achieved in 55% of those on treatment.ConclusionHypertension is as common in people with dementia as in other populations and is as commonly treated with antihypertensive drugs. The findings presented here will support further work to establish the risk-benefit of antihypertensive treatment in patients with dementia and, if differing ratios are identified, to establish dementia-specific guidelines for management.

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Section: Resultsmentioning

confidence: 99%

The treatment of hypertension in people with dementia: a systematic review of observational studies

2014

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“…Alternatively, AD-related cognitive impairments could increase mortality risk because they may hamper diagnosis and management of other diseases or increase the risk for accidents. 29,30 Increased mortality risk may also have resulted from AD pathology, which may compromise the physiological response to other illnesses. 31 However, in order to understand the relation between preclinical AD and mortality, further research is needed.…”

Section: Discussionmentioning

confidence: 99%

Preclinical Alzheimer's disease and its outcome: a longitudinal cohort study

Vos

Xiong²,

Visser

et al. 2013

The Lancet Neurology

484

447

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Background New research criteria for preclinical Alzheimer’s disease (AD)have been proposed by the National Institute on Aging and Alzheimer’s Association. They include stages for cognitively normal individuals with abnormal amyloid markers (stage 1), abnormal amyloid and injury markers (stage 2) and abnormal amyloid and injury markers and subtle cognitive changes (stage 3). We investigated the occurrence and long-term outcome of these stages. Methods Cerebrospinal fluidamyloid-β1–42 and tau levels and a memory composite score were used to classify 311 cognitively normal(Clinical Dementia Rating [CDR]=0) research participants ≥65 years as normal (both markers normal), preclinical AD stage 1–3, or Suspected Non-Alzheimer Pathophysiology (SNAP, abnormal injury marker without abnormal amyloid marker). Outcome measures were progression to CDR≥0·5 symptomatic AD and mortality up to 15 years after baseline (average=4 years). Findings 129 (41·5%) of participants were normal, 47 (15%)were in stage 1, 36 (12%) in stage 2, 13 (4%)in stage 3, 72 (23%) had SNAP, and 14 (4·5%) remained unclassified. The proportion of preclinical AD (stage 1–3) in our cohort was higher in individuals older than 72 years and in APOE-ε4 carriers. The 5-year progression rate to CDR≥0·5 symptomatic AD was 2% for normal participants, 11% for stage 1, 26% for stage 2, 56% for stage 3, and 5% for SNAP. Compared with normal individuals, participants with preclinical AD had an increased risk of death (HR=6·2, p=0·0396). Interpretation Preclinical AD is common in cognitively normal elderly and strongly associated with future cognitive decline and mortality. Preclinical AD thus should be an important target for therapeutic interventions.

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“…Pokela et al reported a similar association between self-reported mobility and analgesic use in older persons [33]. Studies investigating differences in other medications between patients with and without dementia discussed further explanations for undertreatment: Löppönen et al found an undermedication for cardiovascular diseases in patients with dementia, especially a less frequent treatment with antithrombotic agents in stroke and beta-blockers in case of hypertension [34]. They forwarded that caution may be an explanation, as older subjects with dementia are known to have an increased risk of falls leading to trauma.…”

Section: Discussionmentioning

confidence: 99%

Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls

et al. 2014

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BackgroundThe evidence of undertreatment of pain in patients with dementia is inconsistent. This may largely be due to methodological differences and shortcomings of studies. In a large cohort of patients with incident dementia and age- and sex-matched controls we examined (1) how often they receive diagnoses indicating pain, (2) how often they receive analgesics and (3) in which agents and formulations.MethodsUsing health insurance claims data we identified 1,848 patients with a first diagnosis of dementia aged ≥ 65 years and 7,385 age- and sex-matched controls. We analysed differences in diagnoses indicating pain and analgesic drugs prescribed between these two groups within the incidence year. We further fitted logistic regression models and stepwise adjusted for several covariates to study the relation between dementia and analgesics.ResultsOn average, patients were 78.7 years old (48% female). The proportions receiving at least one diagnosis indicating pain were similar between the dementia and control group (74.4% vs. 72.5%; p = 0.11). The proportion who received analgesics was higher in patients with dementia in the crude analysis (47.5% vs. 44.7%; OR: 1.12; 95% CI: 1.01-1.24), but was significantly lower when adjusted for socio-demographic variables, care dependency, comorbidities and diagnoses indicating pain (OR: 0.78; 95% CI: 0.68-0.88). Analgesics in liquid form such as metamizole and tramadol were more often used in dementia.ConclusionsOur findings show a comparable documentation of diagnoses indicating pain in persons with incident dementia compared to those without. However, there still seems to be an undertreatment of pain in patients with dementia. Irrespective of dementia, analgesics seem to be more often prescribed to sicker patients and to control pain in the context of mobility.

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Dementia Associates with Undermedication of Cardiovascular Diseases in the Elderly

Cited by 19 publications

References 75 publications

The treatment of hypertension in people with dementia: a systematic review of observational studies

The treatment of hypertension in people with dementia: a systematic review of observational studies

Preclinical Alzheimer's disease and its outcome: a longitudinal cohort study

Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls

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