Psychotropic Drugs in Patients With Alzheimer's Disease: A Longitudinal Study by the Registry of Dementias of Girona (ReDeGi) in Catalonia, Spain

Calvó-Perxas, Laia; Turró‐Garriga, Oriol; Aguirregomozcorta, Maria; Bisbe, Josep; Hernández, Erélido; López-Pousa, Secundino; Manzano, Anna; Palacios, Mónica; Pericot-Nierga, Imma; Perkal, Héctor; Ramió, Lluís; Vilalta-Franch, Joan; Garré-Olmo, Josep; Batlle, David Genís; Gich, Jordi; Molins, A; Serena, Joaquı́n; Silva, Yolanda; Hernández, Marta; Lejarreta, Saioa; Lozano, Manuela; Pericot, Immaculada; Turon-Estrada, Antoni; Turbau, Josefa; J, Llinas; Alsina, Elisabet; Eugenio, Rosa de; Flaqué, Margarita; Carmona, Olga; Cullell, Marta; Osuna, Teresa; Fernández, Ma del Mar; Linares, Marta; Daniel, Fabian Marquez; Vallmajó, Natàlia; Espada, Fernando; Casadevall, T; Viñas, Marta; Casas, Isabel; Cuy, Josep Ma; Roig, Anna Maria; Coromina, Joan; Soto, Mònica Palacios

doi:10.1016/j.jamda.2014.02.003

Cited by 9 publications

(4 citation statements)

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“…These regional differences in cognitive profile have previously been described for AD [9], and it is interesting to see them replicated for other dementia subtypes (Table 4). Baseline differences in educational attainment may explain these findings [9], especially if we consider the high proportion of cases with low education in the ReDeGi [39]. The Danish registry presents a mean MMSE mean of 20.9 points for all-cause dementia and the French National Alzheimer Database a mean of 16.4 for AD patients, 18.5 for related disorders, and 25.6 for patients with mild cognitive impairment [35, 36].…”

Section: Discussionmentioning

confidence: 99%

“…The lower MMSE score at the time of diagnosis may be related to the greater treatment with antipsychotics; however, high rates of antipsychotic consumption have been previously reported both in the ReDeGi [39, 50] and in Catalonia [51], which warrants further study regarding mortality risks, medication side-effects, and drug-drug interactions. On the other hand, cardiovascular medications were also more common in the ReDeGi than in SveDem, which seems to be in disagreement with the North-South gradient of cardiovascular risk, but may be related with the differences seen on AD/VaD rates.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi)

Garré-Olmo

García-Ptacek

Calvó-Perxas

et al. 2016

JAD

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The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer’s disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03–3.84) for VaD, and 2.15 (1.97–2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39–0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi)

Garré-Olmo

García-Ptacek

Calvó-Perxas

et al. 2016

JAD

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“…In Italy, it is highly possible that the management of psychosis in dementia is not currently done following such guidelines: the recent report on the use of drugs by the Italian Medicines Agency shows a constant increase of use from 2013 to 2017 [5], the same has been reported to occur in Spain [6], while the United Kingdom finally achieved a large reduction of prescriptions from 22,1% in 2005 to 11,4% by 2015 [7].…”

Section: Introductionmentioning

confidence: 99%

Appropriate use of antipsychotic drugs is feasible in outpatients’ dementia clinics

Catarci¹

2018

Neuro Neurosurg

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The use of antipsychotic drugs in patients with dementia is not recommended due to their high mortality index and significant increase of cerebrovascular events, in fact they should be prescribed only when all the other treatments fail or when there is an obvious danger for the patient or his/her caregiver. Nevertheless, the most recent report on the use of drugs by the Italian Medicines Agency shows a constant increase of prescriptions.We retrospectively evaluated the prescription of typical and atypical antipsychotics in 190 patients with dementia visited in a time interval of two years in our outpatients' dementia clinic.We found that 47.9% of them reported more or less severe behavioural symptoms, although 9% only needed antipsychotic drugs. Mini Mental State Examination was assessable in seven out of 17 patients and the scores ranged from five to 23/30.Our results are in line with other larger specialist settings' reports of 6,2% and 11,4%, meaning that careful management of patients with dementia and their caregivers, as it happens in dedicated outpatients' clinics, allows a limited use of antipsychotic drugs.

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“…Patients with Alzheimer's disease are prescribed not only cholinesterase inhibitors, but also psychotropic drugs including antipsychotics, antidepressants, and sedative anxiolytics to relieve a variety of symptoms in clinical practice. 1 , 2 For example, although any antipsychotics were not FDA-approved for the treatment of neuropsychiatric symptoms in dementia, the off-label use of antipsychotics to treat severe neuropsychiatric symptoms such as psychotic symptoms, agitation, and aggression in patients with dementia is increasing. 3 , 4 It is often recommended to consider nonpharmacological before pharmacologic interventions.…”

Section: Introductionmentioning

confidence: 99%

Effect of Psychotropic Drugs on Development of Diabetes Mellitus in Patients With Alzheimer's Disease

et al. 2015

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We aimed to examine risk of diabetes mellitus (DM) among older adults with Alzheimer's disease receiving 3 types of psychotropic drugs, that is, antipsychotics, antidepressants, and sedative anxiolytics.We retrospectively analyzed data from a hospital-based Clinical Research Center for Dementia of South Korea (CREDOS) study conducted between January 1, 2008 and December 31, 2012. Participants (n = 3042) with Alzheimer's disease were aged 65 or older and had no preexisting history of DM. Development of DM was identified using claims for initiating at least 1 prescription of antidiabetic medications or a diagnosis of DM during the follow-up period. Cox proportional hazards regression was used to demonstrate the Hazard ratio of DM in use of each psychotropic drug.Among the 3042 participants, 426 patients (14.0%) developed DM, representing an incidence rate of 5.2/100 person-years during an average 2.9 years of follow-up period. Among the 3 types of psychotropic drugs, antipsychotic users had a significantly higher risk of DM (hazard ratio = 1.74, 95% confidence interval = 1.10, 2.76) than nonusers, after adjusting covariates. Antidepressants and sedative anxiolytics did not achieve statistical significance.These results suggested that the diabetes risk was elevated in Alzheimer patients on antipsychotic treatment. Therefore, patients with Alzheimer's disease receiving antipsychotic treatment should be carefully monitored for the development of DM.

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Psychotropic Drugs in Patients With Alzheimer's Disease: A Longitudinal Study by the Registry of Dementias of Girona (ReDeGi) in Catalonia, Spain

Cited by 9 publications

References 50 publications

Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi)

Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi)

Appropriate use of antipsychotic drugs is feasible in outpatients’ dementia clinics

Effect of Psychotropic Drugs on Development of Diabetes Mellitus in Patients With Alzheimer's Disease

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