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

Abstract

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.

Effect of Gabapentin in a Neuropathic Pain Model in Mice Overexpressing Human Wild-Type or Human Mutated Torsin A

“…Thrombospondins are matrix proteins involved in synaptogenesis [ 45 ], bind to α2δ-1, are upregulated after peripheral nerve injury, and disrupt intracellular Ca2 + signaling due to the interaction with this auxiliary subunit of the calcium channel [ 46 ]. A better understanding of these phenomena is of the utmost importance to clarify the mechanism of action of α2δ-1 ligands such as gabapentin, pregabalin, and the newest mirogabalin [ 47 , 48 ], which is reportedly endowed with neuropsychiatric activities during chronic pain states [ 49 , 50 , 51 ], clinical conditions in which, for instance, these drugs are often inappropriately used in non-communicative patients [ 52 , 53 , 54 ].…”

Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis

“…Indeed, in the real-life clinical setting, the use of opioids in patients with post-stroke pain, who are not able to communicate is frequent, but the response to treatment is unclear (Schuster et al, 2020). Post-stroke pain can occur also in patients with neurodegenerative disorders (Scherder and Plooij, 2012) and clinical trials to assess the efficacy and safety of opioids are needed, being the treatment of pain often inappropriate in this population (Scuteri et al, 2017;Scuteri et al, 2018;Scuteri et al, 2020a;Scuteri et al, 2020b). Future double-blind randomized clinical trials designed specifically for poststroke pain, methodology and statistical power are needed to assess the efficacy and safety of opioids in post-stroke pain and to understand the impact of pain treatment on physical function.…”

Progress in the Treatment of Migraine Attacks: From Traditional Approaches to Eptinezumab

“…Therefore, a clinical trial with the adequate design to investigate the efficacy and safety of eptinezumab in the treatment of acute attacks occurring 2–8 times per month with at least 48 h of pain freedom between attacks and fewer than 15 headache days per month [ 7 ] is needed. Moreover, due to the epidemiology of migraine, generally the eldest population are not included in clinical trials for current abortive treatments, e.g., triptans [ 26 ]: this issue is worsened in patients affected by dementia who do not receive adequate treatment for chronic pain [ 71 , 72 , 73 ]. Hence, this clinical trial should include this fragile population.…”