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Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature260126
Source
Int Clin Psychopharmacol. 2014 Jul;29(4):216-23
Publication Type
Article
Date
Jul-2014
Author
Heidi Taipale
Antti Tanskanen
Marjaana Koponen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
Int Clin Psychopharmacol. 2014 Jul;29(4):216-23
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Cholinesterase Inhibitors - adverse effects - therapeutic use
Cohort Studies
Diagnostic and Statistical Manual of Mental Disorders
Drug Monitoring
Drug Prescriptions
Drug Therapy, Combination - adverse effects
Excitatory Amino Acid Antagonists - adverse effects - therapeutic use
Female
Finland
Follow-Up Studies
Galantamine - adverse effects - therapeutic use
Guideline Adherence
Humans
Indans - adverse effects - therapeutic use
Male
Memantine - adverse effects - therapeutic use
Nootropic Agents - adverse effects - therapeutic use
Phenylcarbamates - adverse effects - therapeutic use
Piperidines - adverse effects - therapeutic use
Practice Guidelines as Topic
Proportional Hazards Models
Registries
Abstract
The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006-2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer's disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295-1458) days and 1103 (interquartile range 489-1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22-1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15-1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer's disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.
Notes
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PubMed ID
24608822 View in PubMed
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Risk factors for nursing home placement in Alzheimer's disease: a longitudinal study of cognition, ADL, service utilization, and cholinesterase inhibitor treatment.

https://arctichealth.org/en/permalink/ahliterature142733
Source
Gerontologist. 2011 Feb;51(1):17-27
Publication Type
Article
Date
Feb-2011
Author
Carina Wattmo
Asa K Wallin
Elisabet Londos
Lennart Minthon
Author Affiliation
Department of Neuropsychiatry, Skåne University Hospital, SE-205 02 Malmö, Sweden. carina.wattmo@skane.se
Source
Gerontologist. 2011 Feb;51(1):17-27
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - physiopathology - psychology
Cholinesterase Inhibitors - adverse effects - therapeutic use
Cognition - drug effects
Female
Galantamine - adverse effects - therapeutic use
Humans
Indans - adverse effects - therapeutic use
Kaplan-Meier Estimate
Male
Middle Aged
Nursing Homes - utilization
Phenylcarbamates - adverse effects - therapeutic use
Piperidines - adverse effects - therapeutic use
Proportional Hazards Models
Prospective Studies
Risk factors
Severity of Illness Index
Sex Factors
Sweden
Abstract
To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and cholinesterase inhibitor treatment (ChEI).
In an open, 3-year, prospective, multicenter study in a routine clinical setting, 880 AD patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Mini-Mental State Examination, Instrumental Activities of Daily Living scale (IADL), and Physical Self-Maintenance scale. Moreover, the dose of ChEI, the amount of weekly assistance (home help service and adult day care), and the date of NHP were recorded. Cox regression models were constructed to predict the risk of NHP.
During the study, 206 patients (23%) were admitted to nursing homes. Factors that precipitated institutionalization were lower cognitive and functional abilities at baseline, faster rate of decline in IADLs, female gender, solitary living, and a lower mean dose of ChEI. The men living alone and patients with a substantial increase in adult day care also demonstrated shorter time to NHP.
The rate of functional but not cognitive decline was a strong risk factor for NHP. The results could be used to identify the care recipients that might risk early NHP to ensure that these individuals receive a sufficient level of assistance. Furthermore, higher doses of ChEI might postpone institutionalization in AD.
PubMed ID
20562471 View in PubMed
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Use of antidementia drugs and risk of pneumonia in older persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature287330
Source
Ann Med. 2017 May;49(3):230-239
Publication Type
Article
Date
May-2017
Author
Pasi Lampela
Anna-Maija Tolppanen
Antti Tanskanen
Jari Tiihonen
Piia Lavikainen
Sirpa Hartikainen
Heidi Taipale
Source
Ann Med. 2017 May;49(3):230-239
Date
May-2017
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Alzheimer Disease - complications - diagnosis - drug therapy
Cholinesterase Inhibitors - adverse effects - therapeutic use
Female
Finland - epidemiology
Galantamine - adverse effects - therapeutic use
Hospitalization
Humans
Indans - adverse effects - therapeutic use
Male
Memantine - adverse effects - therapeutic use
Middle Aged
Piperidines - adverse effects - therapeutic use
Pneumonia - chemically induced - complications - epidemiology - mortality
Risk
Rivastigmine - adverse effects - therapeutic use
Abstract
Persons with Alzheimer's disease are at an increased risk of pneumonia, but the comparative risks during specific antidementia treatments are not known. We compared the risk of pneumonia in the use of donepezil, rivastigmine (oral, transdermal), galantamine and memantine.
We used data from a nationwide cohort of community-dwelling individuals diagnosed with Alzheimer's disease during 2005-2011 in Finland, who initiated monotherapy with acetylcholinesterase inhibitor or memantine (n?=?65,481). The risk of hospitalization or death due to pneumonia was investigated with Cox proportional hazard models.
The risk of pneumonia was higher in persons using rivastigmine patch (n?=?9709) (adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.04-1.27) and memantine (n?=?11,024) (HR 1.59, 95% CI 1.48-1.71) compared with donepezil users (n?=?26,416) whereas oral rivastigmine (n?=?7384) (HR 1.08, 95% CI 0.98-1.19) and galantamine (n?=?10,948) (HR 0.91, 95% CI 0.83-1.00) were not associated with an increased risk. These results did not change when adjusting for comorbid conditions, use of psychotropic drugs or with inverse probability of treatment weighting.
The increased risk of pneumonia in this fragile group of aged persons should be taken into account. Memantine is associated with the highest risk in the comparison of antidementia drugs. KEY Message Pneumonia risk is increased in persons with Alzheimer's disease who use memantine or rivastigmine patches.
PubMed ID
27786552 View in PubMed
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