Prevalence and correlates of psychotropic drug use in Dutch nursing home patients with young‐onset dementia

Abstract

Objectives Neuropsychiatric symptoms (NPSs) in dementia patients in nursing homes are common and often treated with psychotropic drugs. Thus far, studies on psychotropic drug use (PDU) mainly focused on elderly patients with dementia. It is important to know the prevalence and correlates of PDU in patients with young‐onset dementia (YOD) to optimize NPS treatment and reduce excess PDU in this group. Design The Behavior and Evolution in Young‐Onset Dementia (BEYOnD) study is a cross‐sectional study in 230 residents with YOD in eight nursing homes providing specialized YOD care. PDU was registered from medical charts. The influence of age, gender, severity, and type of dementia, NPS, and agitation on PDU was analyzed. Results Eighty‐seven percent of the residents used psychotropic drugs, and 47% used two or more psychotropic drugs. No significant associations with age, gender, dementia subtype, and dementia severity were found. Depressive symptoms showed an association with the use of antidepressants, nighttime behavior with use of hypnotics, and verbal agitation with antipsychotics. Apathy was strongly associated with lower PDU. Conclusions Nursing home patients with YOD have a high prevalence of PDU. The association with NPS raises questions of efficacy of these drugs in managing NPS. Patients with apathy had a lower chance of using psychotropics. More research on indications and effects of psychotropic drugs is needed, as well as on (nonpharmacological) alternatives for managing challenging behavior in YOD.

Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis

“…However, this rate appeared higher on average in our included studies (Md: 13%; Range: 8%-22%) and in studies not exclusively examining residents with dementia (Gulla et al, 2016;Schjøtt and Aßmus, 2019). We also found evidence of antipsychotic-antidepressant combination therapy in the presence of a third psychotropic medication such as an anxiolytic (Gerridzen and Coossensen, 2014;Kim and Whall, 2006;Mulders et al, 2019), all of which may contribute to excessive sedation. Moreover, certain pairings of atypical antipsychotics with SSRI antidepressants may lead to torsades de pointe (e.g.…”

“…From the 287 articles, 262 were excluded for the following reasons: 224 reported no estimate of psychotropic polypharmacy, 27 included NH residents without dementia, 7 studies included community-dwelling older adults, 2 studies had inconsistencies between text, figures, and tables that made data extraction problematic, one study examined psychotropic polypharmacy only in NH residents who received at least one sedative medication, and one study included residents without dementia. This left 25 articles for meta-analysis (Bartels et al, 2003;Bellelli et al, 1998;Eggermont et al, 2009;Gerridzen and Coossensen, 2014;Gustafsson et al, 2013;Jacquin-Piques et al, 2016;Kim and Whall, 2006;Lippert et al, 2020;Massot Mesquida et al, 2019;McMaster et al, 2018;Midlöv et al, 2014;Mjørud et al, 2014a;Mjørud et al, 2014b;Moyle et al, 2017;Mulders et al, 2019;Nijk et al, 2009;Nørgaard et al, 2017;Ozaki et al, 2017;Pasina et al, 2020;Resnick et al, 2019;Rolland et al, 2012;Ryden et al, 1999;Simpson et al, 2006;Vasudev et al, 2015;Wetzels et al, 2011). Figure 1 shows a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart that highlights the screening methodology.…”

“…Of the 25 studies, 17 provided an estimate of psychotropic polypharmacy that encompassed two-or-more medications and 17 provided an estimate of psychotropic polypharmacy that encompassed three-or-more medications (see Table 1). Twelve countries were sampled: Australia (n = 2; McMaster et al, 2018;Moyle et al, 2017), Canada (n = 1; Vasudev et al, 2015), Denmark (n = 1; Nørgaard et al, 2017), France (n = 2; Jacquin- Piques et al, 2016;Rolland et al, 2012), Germany (n = 1; Lippert et al, 2020), Italy (n = 2; Bellelli et al, 1998;Pasina et al, 2020), Japan (n = 1; Ozaki et al, 2017), Netherlands (n = 5; Eggermont et al, 2009;Gerridzen and Coossensen, 2014;Mulders et al, 2019;Nijk et al, 2009;Wetzels et al, 2011), Norway (n = 2; Mjørud et al, 2014a;Mjørud et al, 2014b), Spain (n = 1; Massot Mesquida et al, 2019), Sweden (n = 2; Gustafsson et al, 2013;Midlöv et al, 2014), and the United States (n = 5; Bartels et al, 2003;Kim and Whall, 2006;Resnick et al, 2019;Ryden et al, 1999;Simpson et al, 2006). Included studies were published as early as 1998, though 72.0% (n = 18) were published since 2010.…”

“…Sample sizes ranged from 55 to 59,785 with a median of 312 residents. One study examined early-onset dementia (Mulders et al, 2019) and another study examined residents with Korsakoff's Syndrome (Gerridzen and Coossensen, 2014). The mean percentage of male residents was 27.6% and ranged from 12.0% to 74.6%.…”

End Stage Clinical Features and Cause of Death of Behavioral Variant Frontotemporal Dementia and Young-Onset Alzheimer’s Disease

“…As a result, a high prevalence of psychotropic drug use is reported in young-onset dementia in nursing homes. In particular, this is described with regard to neuropsychiatric symptoms, where it has limited efficacy and is often accompanied with severe side effects [20][21][22]. Moreover, quality of life of the patient is negatively associated with advanced dementia and psychotropic drugs use [23].…”