Prediction of antipsychotics use in patients with mild cognitive impairment and dementia

Abstract

Introduction Antipsychotic medications are widely prescribed to manage neuropsychiatric symptoms (NPS) of dementia. NPS produce a negative impact on the caregiver and represent a cause of institutionalization. The benefit of antipsychotics is controversial and should be the last treatment option. Objective To detect potential predictors of antipsychotic drug (risperidone, quetiapine, olanzapine, clozapine, haloperidol) use in patients with mild cognitive impairment and mild dementia. Methods Data was collected as part of the prospective study of home‐dwelling people with cognitive impairment and their caregivers. The associations between antipsychotic medication use and cognitive‐clinical measures were analyzed using a multivariate binomial generalized linear model. Results 228 patients were evaluated at baseline. MCI and dementia were diagnosed in 125 and 30 subjects respectively. After a median (25th to 75th percentile range) of 4.5 (4.1‐4.9) years 21 patients died. Antipsychotics were prescribed in 46 cases (16 with dementia and 30 with MCI). In the multivariate model, baseline Boston naming test (OR: 0.93, 95% confidence interval: 0.89‐0.98, p=0.004) and instrumental activities of the daily living score (OR: 0.65, 95% confidence interval: 0.47‐0.90, p=0.009) were independently related to antipsychotic use (table). Conclusion Within 4 years of follow‐up, thirty percent of the patients with cognitive impairment received antipsychotic drugs. Baseline instrumental activity of the daily living and Boston naming test were identified as independent predictors.

Dementia risk predictions from German claims data using methods of machine learning

“…By far the most important feature for predicting dementia in general and in our study is age. Also outstanding are antipsychotics (N05A), which are used frequently to treat a range of psychiatric symptoms 32 as well as for the pre‐dementia stage of MCI 33,34 . Although the evidence for the benefit of antidementia drugs (N06D) in the pre‐dementia stage is inconclusive, 35 they are widely used in clinical practice 36 .…”

“…Also outstanding are antipsychotics (N05A), which are used frequently to treat a range of psychiatric symptoms 32 as well as for the pre-dementia stage of MCI. 33,34 Although the evidence for the benefit of antidementia drugs (N06D) in the pre-dementia stage is inconclusive, 35 they are widely used in clinical practice. 36 Note that the high importance of anti-dementia drugs may also indicate a high of undiagnosed dementia cases, especially for individuals phase of conversion from MCI to dementia, which is a phase of high uncertainty.…”