Antidopaminergic‐Antiparkinsonian Medication Prescribing Cascade in Persons with Alzheimer's Disease

Abstract

OBJECTIVES: Persons living with Alzheimer's disease (AD) may be at increased risk for prescribing cascades due to greater multimorbidity, polypharmacy, and the need for more complex care. Our objective was to assess the proportion of the antidopaminergic-antiparkinsonian medication prescribing cascades among persons living with Alzheimer's disease. SETTING: Two large administrative claims databases in the United States. PARTICIPANTS: We identified patients aged ≥50 on January 1, 2017, who were dispensed a drug used to treat Alzheimer's disease for at least 1 day in the 365 days prior to or on cohort entry date and who had medical and pharmacy coverage in the 365 days prior to the cohort entry date. We excluded individuals with a recent institutional stay. We identified incident antidopaminergic (antipsychotic/metoclopramide) use in the 183 days following cohort entry and identified subsequent incident antiparkinsonian drug use within 8 to 365 days. RESULTS: There were 121,538 patients with Alzheimer's disease eligible for inclusion. Approximately 62% were women with a mean age of 79.5 (SD AE 8.6). The mean number of drugs dispensed was 9.2 (SD AE 4.9). There were 36 incident antiparkinsonian users among 4,534 incident antipsychotic/metoclopramide users (0.8%). CONCLUSION: We determined that the proportion of antidopaminergic-antiparkinsonian medication prescribing cascades, widely considered as high-priority, was low. Our approach can be used to assess the proportion of prescribing cascades in populations considered to be at high risk and to prioritize system-level interventional efforts to improve medication safety in these patients.

Prescribing cascades in community‐dwelling adults: A systematic review

“…Most studies ( n = 88) were retrospective cohort studies, 5 , 7 , 18 , 21 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

“… 24 , 26 , 30 , 41 , 44 , 50 , 53 , 74 , 117 and parkinsonism ( n = 9). 27 , 29 , 30 , 31 , 46 , 57 , 63 , 82 , 119 …”

“…No association between drug pairs could be determined for several studies, largely due to either a cross‐sectional study design examining concurrent drug use, insufficient drug‐pair sample size to determine a sequence ratio or reporting of incidence rates with no incidence rate ratio (labelled N/A in Figure 2 ). 6 , 21 , 25 , 30 , 43 , 46 , 53 , 55 , 63 , 64 , 78 , 79 , 112 , 114 , 115 Several studies reported at least one negative association between drug pairs, indicating a reduced likelihood of the second medication being initiated (see eTable 3 Appendix S1 ). 33 , 60 , 68 , 69 , 70 , 74 , 81 , 87 , 89 , 93 , 111 …”

Prescribing cascades in community-dwelling adults: a systematic review

“…107 The suspected ADRs, symptoms or new diagnoses explored were broad-ranging (see Table 2) most commonly depression (n=13) 33,37,40,45,52,55,57,73,95,99,100,112,114 ; peripheral oedema (n=11) [5][6][7]28,36,64,81,98,[105][106][107]118 ; urinary incontinence (n=9). 24,26,41,44,50,53,75,81,119 and parkinsonism (n=9) 27,29,31,46,57,81,84,123,124…”

“…91,93,103 No association between drug pairs could be determined for several studies, largely due to either a crosssectional study design examining concurrent drug use, insufficient drug-pair sample size to determine a sequence ratio or reporting of incidence rates with no incidence rate ratio (labelled N/A in Figure 2). 6,21,25,43,46,53,55,64,81,114,116,117,123,125,126 Several studies reported at least one negative association between drug pairs, indicating a reduced likelihood of the second medication being initiated (see eTable 3 Supplementary materials). 33,60,[68][69][70]75,83,89,91,95,113 Modifiers of identified associations Older people (aged [?…”