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Antipsychotic doses among community-dwelling persons with Alzheimer disease in Finland.

https://arctichealth.org/en/permalink/ahliterature266764
Source
J Clin Psychopharmacol. 2014 Aug;34(4):435-40
Publication Type
Article
Date
Aug-2014
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
J Clin Psychopharmacol. 2014 Aug;34(4):435-40
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - administration & dosage
Cohort Studies
Dose-Response Relationship, Drug
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Residence Characteristics
Abstract
Use of antipsychotics for treatment of behavioral and psychological symptoms of dementia is frequent among persons with Alzheimer disease (AD). Doses used in long-term therapy have not been previously reported. We describe antipsychotic doses used among community-dwelling persons with AD and investigate factors associated with high-dose use. The MEDALZ-2005 (Medication use and Alzheimer disease) cohort is a nationwide sample including all persons with clinically diagnosed AD at the end of year 2005 in Finland (n = 28,093). Data including prescriptions, comorbidities, and hospital discharge diagnoses were collected from nationwide registers. Antipsychotic doses in monotherapy were investigated during 2006 to 2009. Among 8920 antipsychotic users, 4% (n = 336) used antipsychotics with high dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics. High-dose use was associated with younger age (
PubMed ID
24875073 View in PubMed
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Antipsychotic polypharmacy among a nationwide sample of community-dwelling persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature261391
Source
J Alzheimers Dis. 2014;41(4):1223-8
Publication Type
Article
Date
2014
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
J Alzheimers Dis. 2014;41(4):1223-8
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - therapeutic use
Cohort Studies
Confidence Intervals
Databases, Factual - statistics & numerical data
Female
Finland
Humans
Male
Middle Aged
Polypharmacy
Residence Characteristics
Abstract
Antipsychotic polypharmacy (APP) is not recommended in treatment of behavioral and psychological symptoms of dementia (BPSD). There is lack of studies concerning prevalence of APP among persons with dementia.
The objective of our study was to describe prevalence and risk factors associated with antipsychotic polypharmacy among antipsychotic users with Alzheimer's disease (AD).
Data from nationwide MEDALZ-2005 cohort including all community-dwelling persons diagnosed with AD in Finland was utilized. Register-based data included prescriptions, comorbidities, and hospital discharge diagnoses. Users of antipsychotics during 2006-2009 were included (n = 9,803). The risk of starting antipsychotic polypharmacy was evaluated with Cox proportional hazards model.
Prevalence of antipsychotic polypharmacy was 8% (n = 750) among antipsychotic users (n = 9,803). Quetiapine and risperidone was the most common combination of two antipsychotics followed by combination of quetiapine and haloperidol. Antipsychotic polypharmacy was associated with younger age (HR 1.35 [Confidence Interval, CI, 1.16-1.56]), male gender (HR 1.18 [CI 1.02-1.38]), and history of psychiatric disorder (HR 1.50 [CI 1.26-1.78]) in the adjusted model.
In conclusion, we found higher prevalence of APP than previously reported among older populations. This is concerning since effectiveness of APP has not been demonstrated and APP is not recommended in the treatment of BPSD. Clinicians should pay more attention to avoid APP and use of antipsychotics to other indications than BPSD among persons with AD.
PubMed ID
24787914 View in PubMed
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Differences in drug therapy between dementia disorders in the Swedish dementia registry: a nationwide study of over 7,000 patients.

https://arctichealth.org/en/permalink/ahliterature115627
Source
Dement Geriatr Cogn Disord. 2013;35(5-6):239-48
Publication Type
Article
Date
2013
Author
Kristina Johnell
Dorota Religa
Maria Eriksdotter
Author Affiliation
Aging Research Center, Karolinska Institutet and Stockholm University, SE–113 30 Stockholm, Sweden. Kristina.Johnell@ki.se
Source
Dement Geriatr Cogn Disord. 2013;35(5-6):239-48
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - therapeutic use
Dementia - drug therapy - epidemiology - psychology
Dementia, Vascular - epidemiology - psychology
Female
Humans
Institutionalization
International Classification of Diseases
Lewy Body Disease - drug therapy
Logistic Models
Male
Middle Aged
Neuropsychological Tests
Nootropic Agents - therapeutic use
Registries
Sweden - epidemiology
Abstract
We aimed to study whether there are differences between dementia disorders and the use of anti-dementia drugs and antipsychotics (neuroleptics) in a large population of dementia patients.
Information about dementia disorders was obtained from the national Swedish Dementia Registry (SveDem) 2007-2010 (n = 7,570). Multivariate logistic regression analysis was performed to investigate the association between dementia disorders and the use of anti-dementia drugs and antipsychotics, after adjustment for age, sex, residential setting, living alone, MMSE score and number of other drugs (a proxy for overall co-morbidity).
More than 80% of the Alzheimer's disease (AD) and 86% of dementia with Lewy bodies (DLB) patients used anti-dementia drugs. Women were more likely than men to be treated with cholinesterase inhibitors. A higher MMSE score was positively associated with the use of cholinesterase inhibitors, but negatively associated with NMDA receptor antagonists and antipsychotics. Use of antipsychotics was 6% overall; however, it was 16% in DLB patients with an adjusted odds ratio of 4.2 compared to AD patients.
Use of anti-dementia drugs in AD was in agreement with Swedish guidelines. However, use of antipsychotics in DLB patients was high, which might be worrying given the susceptibility of DLB patients to antipsychotics.
PubMed ID
23485654 View in PubMed
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Do continued antidepressants protect against dementia in patients with severe depressive disorder?

https://arctichealth.org/en/permalink/ahliterature131796
Source
Int Clin Psychopharmacol. 2011 Nov;26(6):316-22
Publication Type
Article
Date
Nov-2011
Author
Lars Vedel Kessing
Julie Lyng Forman
Per Kragh Andersen
Author Affiliation
Psychiatric Center Copenhagen, Rigshospitalet, University Hospital of Copenhagen, Denmark. lars.vedel.kessing@regionh.dk
Source
Int Clin Psychopharmacol. 2011 Nov;26(6):316-22
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - drug therapy - epidemiology - psychology
Antidepressive Agents - adverse effects - therapeutic use
Comorbidity
Dementia - drug therapy - epidemiology - prevention & control
Denmark - epidemiology
Depressive Disorder - drug therapy - epidemiology
Disease Progression
Female
Hospitals
Humans
Inpatients
Male
Middle Aged
Neuroprotective Agents - adverse effects - therapeutic use
Outpatients
Registries
Risk
Serotonin Uptake Inhibitors - adverse effects - therapeutic use
Treatment Outcome
Abstract
Studies on humans show that depressive disorder is associated with an increased risk of developing cognitive dysfunction, and animal studies suggest that antidepressants may have neuroprotective abilities. On the basis of these observations, it was hypothesized that treatment with antidepressants may decrease the risk of developing dementia in patients with depression. We investigated whether continued treatment with antidepressants is associated with a decreased rate of dementia in a population of patients discharged from psychiatric healthcare service with a diagnosis of depression. We used register data on all prescribed antidepressants in all patients discharged from psychiatric healthcare service with a diagnosis of depression and with subsequent diagnoses of dementia in Denmark from 1995 to 2005. A total of 37 658 patients with a diagnosis of depression at their first psychiatric contact and who were exposed to antidepressants after discharge were included in the study. A total of 2007 patients (5.3%) were subsequently diagnosed with dementia of any kind. The rate of dementia decreased during periods of two or more prescriptions of older antidepressants compared with the period of only one prescription of older antidepressants [relative risk (RR)=0.83 (95% confidence interval (CI)=0.70-0.98)]. This finding was replicated with Alzheimer's disease as the outcome [RR=0.66 (95% CI=0.47-0.94)] but not with dementia of other kinds as the outcome [RR=0.88 (95% CI=0.73-1.06)]. In contrast, during periods of continued use of selective serotonin reuptake inhibitors or newer nonselective serotonin reuptake inhibitors, the rate of dementia was not decreased, regardless of the subtype of dementia. It was concluded that continued long-term treatment with older antidepressants is associated with a reduced rate of dementia in patients treated in psychiatric healthcare settings, whereas continued treatment with other kinds of antidepressants is not. Methodological reasons for these findings cannot be excluded because of the nonrandomized nature of data.
PubMed ID
21876440 View in PubMed
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Impact of opioid initiation on antipsychotic and benzodiazepine and related drug use among persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature300965
Source
Int Psychogeriatr. 2018 07; 30(7):947-956
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2018
Author
Aleksi Hamina
Piia Lavikainen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Heidi Taipale
Author Affiliation
Kuopio Research Centre of Geriatric Care,University of Eastern Finland,Kuopio,Finland.
Source
Int Psychogeriatr. 2018 07; 30(7):947-956
Date
07-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Alzheimer Disease - drug therapy - epidemiology - psychology
Analgesics, Opioid - administration & dosage
Antipsychotic Agents - therapeutic use
Benzodiazepines - therapeutic use
Cognition - drug effects
Female
Finland - epidemiology
Humans
Independent Living - psychology - statistics & numerical data
Interrupted Time Series Analysis
Male
Medication Adherence - psychology - statistics & numerical data
Pharmacoepidemiology
Prevalence
Registries - statistics & numerical data
Risk assessment
Risk factors
Abstract
ABSTRACTBackground:We analyzed the impact of opioid initiation on the prevalence of antipsychotic and benzodiazepine and related drug (BZDR) use among community-dwelling persons with Alzheimer's disease (AD).
We utilized the register-based Medication use and Alzheimer's disease (MEDALZ) cohort for this study. We included all community-dwelling persons diagnosed with AD during 2010-2011 in Finland initiating opioid use (n = 3,327) and a matched cohort of persons not initiating opioids (n = 3,325). Interrupted time series analyses were conducted to compare the prevalence of antipsychotic and BZDR use in 30-day periods within six months before opioid initiation to 30-day periods six months later.
Before opioid initiation, prevalence of antipsychotic use among opioid initiators was 13.3%, 18.3% at opioid initiation, and 17.3% six months later. Prevalences of BZDR use were 27.1% six months prior, 28.9% at opioid initiation, and 26.9% six months later. After opioid initiation, antipsychotic and BZDR use declined by 0.3 percentage points (pps, 95% confidence interval 0.1-0.5) and 0.4 pps (0.2-0.7) per month, respectively, until the end of the follow-up. Compared to persons not initiating opioid use, opioid initiation immediately resulted in an increase in prevalence of 1.9 pps (0.9-2.8) for antipsychotics and of 1.6 pps (0.9-2.2) for BZDR use. However, in total there was a comparative decrease of 0.5 pps (0.3-0.8) per month for antipsychotics and of 0.4 pps (0.2-0.6) for BZDR use until the end of the follow-up.
Our results suggest that opioid initiation may reduce antipsychotic and BZDR use among persons with AD.
PubMed ID
29559009 View in PubMed
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Living Alone with Alzheimer's Disease: Data from SveDem, the Swedish Dementia Registry.

https://arctichealth.org/en/permalink/ahliterature292004
Source
J Alzheimers Dis. 2017; 58(4):1265-1272
Publication Type
Journal Article
Date
2017
Author
Pavla Cermakova
Maja Nelson
Juraj Secnik
Sara Garcia-Ptacek
Kristina Johnell
Johan Fastbom
Lena Kilander
Bengt Winblad
Maria Eriksdotter
Dorota Religa
Author Affiliation
Department of Neurobiology, Care Sciences andSociety, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.
Source
J Alzheimers Dis. 2017; 58(4):1265-1272
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology - psychology
Antidepressive Agents
Antipsychotic Agents - therapeutic use
Cohort Studies
Comorbidity
Dementia - epidemiology - psychology
Female
Humans
Independent living
Magnetic Resonance Imaging
Male
Registries
Social Conditions
Sweden - epidemiology
Abstract
Many people with Alzheimer's disease (AD) live alone in their own homes. There is a lack of knowledge about whether these individuals receive the same quality of diagnostics and treatment for AD as patients who are cohabiting.
To investigate the diagnostic work-up and treatment of community-dwelling AD patients who live alone.
We performed a cross-sectional cohort study based on data from the Swedish Dementia Registry (SveDem). We studied patients diagnosed with AD between 2007 and 2015 (n?=?26,163). Information about drugs and comorbidities was acquired from the Swedish Prescribed Drug Register and the Swedish Patient Register.
11,878 (46%) patients lived alone, primarily older women. After adjusting for confounders, living alone was inversely associated with receiving computed tomography (OR 0.90; 95% CI 0.82-0.99), magnetic resonance imaging (OR 0.91; 95% CI 0.83-0.99), and lumbar puncture (OR 0.86; 95% CI 0.80-0.92). Living alone was also negatively associated with the use of cholinesterase inhibitors (OR 0.81; 95% CI 0.76; 0.87), memantine (OR 0.77; 95% CI 0.72; 0.83), and cardiovascular medication (OR 0.92; 0.86; 0.99). On the other hand, living alone was positively associated with the use of antidepressants (OR 1.15; 95% CI 1.08; 1.22), antipsychotics (OR 1.41; 95% CI 1.25; 1.58), and hypnotics and sedatives (OR 1.09; 95% CI 1.02; 1.17).
Solitary living AD patients do not receive the same extent of care as those who are cohabiting.
Notes
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PubMed ID
28550260 View in PubMed
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Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland.

https://arctichealth.org/en/permalink/ahliterature131871
Source
Int Psychogeriatr. 2011 Dec;23(10):1623-31
Publication Type
Article
Date
Dec-2011
Author
Marja-Liisa Laitinen
J Simon Bell
Piia Lavikainen
Eija Lönnroos
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. marja-liisa.laitinen@uef.fi
Source
Int Psychogeriatr. 2011 Dec;23(10):1623-31
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - drug effects - psychology
Alzheimer Disease - drug therapy - epidemiology - psychology
Antipsychotic Agents - administration & dosage - therapeutic use
Case-Control Studies
Female
Finland - epidemiology
Humans
Male
Social Environment
Abstract
Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.
The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.
The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91-6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions - 67.8% in the AD and 62.9% in the non-AD group - were generated in primary care situations.
One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.
PubMed ID
21867581 View in PubMed
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Use of Anti-Dementia Drugs in Relation to Change in Cognition, Behavior, and Functioning in Alzheimer's Disease over a Three-Year Period: Kuopio ALSOVA Study.

https://arctichealth.org/en/permalink/ahliterature275027
Source
J Alzheimers Dis. 2015;48(4):1033-41
Publication Type
Article
Date
2015
Author
Soili M Törmälehto
Janne A Martikainen
Saku T Väätäinen
Ilona T Hallikainen
Merja Hallikainen
J Simon Bell
Anne M Koivisto
Source
J Alzheimers Dis. 2015;48(4):1033-41
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - drug therapy - epidemiology - psychology
Cholinesterase Inhibitors - therapeutic use
Cognition - drug effects
Disease Progression
Drug Therapy, Combination
Female
Finland - epidemiology
Follow-Up Studies
Humans
Logistic Models
Male
Memantine - therapeutic use
Neuropsychological Tests
Nootropic Agents - therapeutic use
Odds Ratio
Prevalence
Prospective Studies
Severity of Illness Index
Treatment Outcome
Abstract
Alzheimer's disease (AD) is characterized by deterioration in cognition, decline in physical function, and increase in behavioral disturbances. These symptoms are associated with dependence.
We investigated the use of anti-dementia drugs in relation to change in cognition, function, and behavior over a 3-year period.
Data were collected as part of the prospective follow-up ALSOVA study. All study participants (n = 236) had very mild or mild AD at baseline. All participants and their informal caregivers underwent annual clinical and medication assessments. Repeated measures logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with anti-dementia drug use and disease progression measures over time.
The overall prevalence of anti-dementia drug use remained stable (from 89% to 92%) during the follow-up period. The use of memantine and cholinesterase inhibitor-memantine combination treatment increased with disease severity. After adjustment for confounding, a one-point increase in the disease severity scale (CDR-SOB) was associated with 15.6% increased odds of memantine use. A one-point decrease in CERAD Neuropsychological battery (CERAD-NB) total score was associated with 2.4% increased odds of memantine use. The overall unadjusted rate of switching between anti-dementia drugs was 9.17 (95% CI 7.10 to 11.88) changes per 100 person-years.
Nearly 90% of newly diagnosed persons with AD were prescribed anti-dementia drugs. Use of memantine was found to be associated with disease progression. Switching and use of anti-dementia drugs was consistent with Finnish and European clinical practice guidelines for AD.
PubMed ID
26444756 View in PubMed
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8 records – page 1 of 1.