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Duration of new antidepressant use and factors associated with discontinuation among community-dwelling persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature300475
Source
Eur J Clin Pharmacol. 2019 Mar; 75(3):417-425
Publication Type
Journal Article
Date
Mar-2019
Author
Reetta Kettunen
Heidi Taipale
Anna-Maija Tolppanen
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Marjaana Koponen
Author Affiliation
School of Pharmacy, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.
Source
Eur J Clin Pharmacol. 2019 Mar; 75(3):417-425
Date
Mar-2019
Language
English
Publication Type
Journal Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Antidepressive Agents - administration & dosage - therapeutic use
Antipsychotic Agents - administration & dosage - therapeutic use
Cohort Studies
Female
Finland
Humans
Independent living
Male
Proportional Hazards Models
Registries
Sex Factors
Time Factors
Abstract
To study how long antidepressants initiated after diagnoses of Alzheimer's disease (AD) were used and factors associated with discontinuation of use among persons with Alzheimer's disease (AD). In addition, differences in duration of use between the antidepressants groups were compared.
Register-based Medication use and Alzheimer's disease (MEDALZ) cohort included 70,718 community-dwelling people with AD who were diagnosed during the years 2005-2011. For this study, the new antidepressant users were included after 1-year washout period (N?=?16,501; 68.6% females, mean age 80.9). The duration of antidepressant use was modeled with the PRE2DUP method. Factors associated with treatment discontinuation were assessed with Cox proportional hazard models and included age, gender, comorbid conditions and concomitant medications.
Median duration of the new antidepressant use period was 309 days (IQR 93-830). For selective serotonin reuptake inhibitor (SSRI) use, the median duration was 331 days (IQR 101-829), for mirtazapine 202 days (IQR 52-635), and for serotonin and norepinephrine reuptake inhibitors (SNRIs) 134 days (IQR 37-522). After 1-year follow-up, 40.8% had discontinued antidepressant use, 54.6% after 2 years and 64.1% after 3 years. Factors associated with treatment discontinuation were age over 85, male gender, diabetes, and use of memantine, opioids, and antiepileptics whereas benzodiazepines and related drugs and antipsychotic use were inversely associated with discontinuation.
Antidepressants are used for long-term among people with AD. Need and indication for antidepressant use should be assessed regularly as evidence on their efficacy for behavioral and psychological symptoms of dementia is limited.
PubMed ID
30413841 View in PubMed
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Hospitalization after Oral Antibiotic Initiation in Finnish Community Dwellers with and without Alzheimer's Disease: Retrospective Register-Based Cohort Study.

https://arctichealth.org/en/permalink/ahliterature301951
Source
J Alzheimers Dis. 2018; 64(2):437-445
Publication Type
Journal Article
Date
2018
Author
Heli Järvinen
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Jari Tiihonen
Anna-Maija Tolppanen
Sirpa Hartikainen
Author Affiliation
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Source
J Alzheimers Dis. 2018; 64(2):437-445
Date
2018
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology
Anti-Bacterial Agents - therapeutic use
Cohort Studies
Communicable Diseases - drug therapy - epidemiology
Female
Finland
Hospitalization - statistics & numerical data
Humans
Independent living
Male
Registries
Abstract
Persons with Alzheimer's disease (AD) are frequently hospitalized from infection-related causes. There are no previous studies investigating hospitalization associated with antibiotic initiation in persons with AD.
To investigate the frequency and risk of hospitalization associated with oral antibiotic initiation among community dwellers with and without AD.
We performed a retrospective register-based study utilizing register-based Medication Use and Alzheimer's disease (MEDALZ) cohort. It includes all community dwellers diagnosed with AD during 2005-2011 in Finland and their matched comparison persons without AD. Antibiotic use was initiated by 34,785 persons with and 36,428 without AD. Drug use data were collected from Prescription Register and comorbidities from Special Reimbursement and Hospital Care Registers. Infection diagnoses were collected from the Hospital Care Register. Factors associated with hospitalization were estimated utilizing logistic regression models.
Risk of hospitalization following antibiotic initiation was higher among antibiotic initiators with AD than without AD (adjusted odds ratio, aOR, 1.37, 95% Cl 1.28-1.46).Strongest association with hospitalization was found for oral glucocorticoid use, aOR 1.41 (1.25-1.59); epilepsy, aOR 1.33 (1.10-1.63); and active cancer, aOR 1.30 (1.14-1.49). Among initiators of cephalexin, pivmecillinam, amoxicillin/amoxicillin, and enzyme inhibitor and doxycycline, persons with AD were more frequently hospitalized than persons without AD. A quarter of hospitalized antibiotic initiators had infection diagnosis in their hospital care records.
Persons with AD initiating an antibiotic had a higher risk for hospitalization than antibiotic initiators without AD. Further research is needed to determine whether infection-related hospitalization could be reduced.
PubMed ID
29914029 View in PubMed
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Incidence of antidepressant use in community-dwelling persons with and without Alzheimer's disease: 13-year follow-up.

https://arctichealth.org/en/permalink/ahliterature295340
Source
Int J Geriatr Psychiatry. 2017 01; 32(1):94-101
Publication Type
Journal Article
Date
01-2017
Author
Arto Puranen
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Int J Geriatr Psychiatry. 2017 01; 32(1):94-101
Date
01-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - complications - drug therapy - psychology
Antidepressive Agents - administration & dosage - adverse effects - therapeutic use
Depression - complications - drug therapy - psychology
Female
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Independent living
Male
Middle Aged
Serotonin Uptake Inhibitors - administration & dosage - therapeutic use
Time Factors
Abstract
The study aimed to investigate the incidence of antidepressant use in persons with and without Alzheimer's disease (AD) from 9?years before to 4?years after AD diagnosis and to examine the incidence of different antidepressant groups.
We used register-based data from the Medication use and Alzheimer's disease cohort including all Finnish persons diagnosed with AD in 2005-2011 with their age-matched and gender-matched comparison persons without AD. In this study, 62,104 persons with AD and 62,104 comparison persons were included. Data on dispensed antidepressants during 1995-2012 were collected from the Prescription Register. A 1-year washout period was utilized to measure the rate of new antidepressant users every 6-month period starting from 9?years before and until 4?years after the AD diagnoses. The incidence rate between persons with and without AD was compared with Poisson regression.
The incidence of antidepressant use in persons with AD was higher during the whole study period compared with that in persons without AD. The incidence rate was highest at 6?months after AD diagnosis (incidence rate ratio?=?5.22, 95% confidence interval 4.77-5.72). Selective serotonin reuptake inhibitors were the most frequently initiated group (61.3% of initiations in persons with AD).
The incidence of antidepressant use was higher in persons with AD than in comparison persons, and it was not explained by history of hospital-treated psychiatric disorders. Widespread use of antidepressants in persons with AD is concerning as their efficacy is controversial and their use is associated with adverse events. Copyright © 2016 John Wiley & Sons, Ltd.
PubMed ID
26924266 View in PubMed
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Incident opioid use and risk of hip fracture among persons with Alzheimer disease: a nationwide matched cohort study.

https://arctichealth.org/en/permalink/ahliterature301336
Source
Pain. 2019 Feb; 160(2):417-423
Publication Type
Journal Article
Date
Feb-2019
Author
Heidi Taipale
Aleksi Hamina
Niina Karttunen
Marjaana Koponen
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Anna-Maija Tolppanen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Pain. 2019 Feb; 160(2):417-423
Date
Feb-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - complications - epidemiology
Cohort Studies
Female
Finland - epidemiology
Hip Fractures - epidemiology - etiology
Humans
Incidence
Independent living
Male
Opioid-Related Disorders - epidemiology
Proportional Hazards Models
Abstract
The objective of this study was to investigate whether incident opioid use is associated with an increased risk of hip fractures among community-dwelling persons with Alzheimer disease (AD) and to assess the association in terms of duration of use and opioid strength. Among community-dwelling persons with AD diagnosed in 2010 to 2011 (N = 23,100), a matched cohort study comparing incident opioid users (N = 4750) with opioid nonusers (N = 4750) was constructed. Matching was based on age, sex, and time since AD diagnosis at opioid initiation. Data on drug use and hip fractures were retrieved from nationwide registers. Incident opioid users were identified with a 1-year washout. Cox proportional hazard models compared the risk of hip fracture between opioid use and nonuse, and were weighted with inverse probability of treatment (IPT), based on a propensity score. Age-adjusted incidence rate of hip fractures was 3.47 (95% confidence interval [CI] 2.62-4.33) during opioid use and 1.94 (95% CI 1.65-2.22) during nonuse. Opioid use was associated with an increased risk of hip fracture (IPT-weighted hazard ratio [HR] 1.96, 95% CI 1.27-3.02). The risk was observed during the first 2 months of use (IPT-weighted HR 2.37, 1.04-5.41) and attenuated after that. The results suggest an increase in the risk of hip fracture by increasing opioid strength; weak opioids IPT-weighted HR 1.75 (0.91-3.35), buprenorphine IPT-weighted HR 2.10 (1.41-3.13), and strong opioids IPT-weighted HR 2.89 (1.32-6.32). Further research is needed to find out whether the risk of injurious falls is avoidable by slow titration of opioid doses in the beginning of treatment.
PubMed ID
30325873 View in PubMed
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Long-term use of benzodiazepines and related drugs among community-dwelling individuals with and without Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature270647
Source
Int Clin Psychopharmacol. 2015 Jul;30(4):202-8
Publication Type
Article
Date
Jul-2015
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
Int Clin Psychopharmacol. 2015 Jul;30(4):202-8
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis - epidemiology - psychology
Benzodiazepines - administration & dosage - adverse effects
Case-Control Studies
Cognition - drug effects
Comorbidity
Drug Administration Schedule
Drug Prescriptions
Drug Utilization Review
Female
Finland - epidemiology
Humans
Inappropriate Prescribing
Independent living
Male
Practice Patterns, Physicians'
Prevalence
Registries
Risk assessment
Risk factors
Sex Factors
Time Factors
Treatment Outcome
Abstract
The aim of this study was to investigate the prevalence of benzodiazepine and related drug (BZDR) use, especially long-term use, and associated factors among community-dwelling individuals with and without Alzheimer's disease (AD). We utilized data from the MEDALZ-2005 cohort, which includes all community-dwelling individuals diagnosed with AD in Finland at the end of 2005 and matched comparison individuals without AD. Register-based data included prescription drug purchases, comorbidities, and hospital discharge diagnoses. In this study, 24,966 individuals with AD and 24,985 individuals without AD were included. During the 4-year follow-up, we found that 45% (N = 11,312) of individuals with AD and 38% (N = 9534) of individuals without AD used BZDRs. The prevalence of long-term (= 180 days) BZDR use was more common among individuals with AD (30%) than individuals without AD (26%). The median durations of the first long-term use periods of BZDRs were 1.5 and 2 years for individuals with and without AD, respectively. Factors associated with long-term BZDR use included female sex, AD, schizophrenia, bipolar disorder, depression, coronary artery disease, and asthma/chronic obstructive pulmonary disease. The high prevalence of long-term BZDR use among individuals with AD is especially a cause for concern because long-term use may further impair cognition and may be associated with serious adverse events.
PubMed ID
26011780 View in PubMed
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Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer's disease: a nationwide matched cohort study.

https://arctichealth.org/en/permalink/ahliterature291878
Source
Alzheimers Res Ther. 2017 Aug 01; 9(1):59
Publication Type
Journal Article
Date
Aug-01-2017
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Piia Lavikainen
Reijo Sund
Jari Tiihonen
Sirpa Hartikainen
Anna-Maija Tolppanen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland. heidi.taipale@uef.fi.
Source
Alzheimers Res Ther. 2017 Aug 01; 9(1):59
Date
Aug-01-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology
Antidepressive Agents - therapeutic use
Case-Control Studies
Cohort Studies
Craniocerebral Trauma - complications - diagnosis - epidemiology
Depression - drug therapy - epidemiology
Female
Finland
Humans
Independent living
Male
Middle Aged
Proportional Hazards Models
Psychiatric Status Rating Scales
Risk factors
Abstract
Antidepressant use has been associated with an increased risk of falling, but no studies have been conducted on whether antidepressant use is associated with an increased risk of head injuries which often result from falling among older persons. The objective of this study was to investigate the risk of head and brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer's disease.
A matched cohort study was conducted by comparing new antidepressant users (n?=?10,910) with two matched nonusers (n?=?21,820) in the MEDALZ study cohort. The MEDALZ cohort includes all community-dwelling persons newly diagnosed with Alzheimer's disease between 2005 and 2011 in Finland. Incident antidepressant users were identified based on register-based dispensing data from the Prescription register with a 1-year washout period for antidepressant use. Nonusers were matched with users based on age, gender, and time since Alzheimer's disease diagnosis. The outcome events were defined as any head injuries and traumatic brain injuries based on diagnoses in Hospital Discharge and Causes of Death registers. Propensity score adjusted Cox proportional hazard models were utilized. Sensitivity analyses with case-crossover design were conducted. All registers are linkable with unique personal identification numbers assigned for each resident.
Antidepressant use was associated with an increased risk of head injuries (age-adjusted event rate per 100 person-years 2.98 (95% confidence interval (CI) 2.49-3.06) during use and 2.43 (95% CI 2.06-2.35) during nonuse, adjusted hazard ratio (HR) 1.35, 95% CI 1.20-1.52) and traumatic brain injuries (age-adjusted event rate per 100 person-years 1.33 (95% CI 1.13-1.53) during use and 1.10 (95% CI 1.00-1.20) during nonuse, adjusted HR 1.26, 95% CI 1.06-1.50). The risk was highest during the first 30 days of use (HR 1.71, 95% CI 1.10-2.66 for head injuries; HR 2.06, 95% CI 1.12-3.82 for traumatic brain injuries) and remained at an elevated level for head injuries for over 2 years of use. In case-crossover analyses, antidepressant use was consistently associated with a higher risk of head injuries.
Antidepressant use was associated with an increased risk of the most severe outcomes, head and brain injuries, in persons with Alzheimer's disease. Antidepressant use should be carefully considered and the association confirmed in future studies.
Notes
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PubMed ID
28764750 View in PubMed
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Systemic Estrogen Use and Discontinuation After Alzheimer's Disease Diagnosis in Finland 2005-2012: A Nationwide Exposure-Matched Cohort Study.

https://arctichealth.org/en/permalink/ahliterature297698
Source
Drugs Aging. 2018 11; 35(11):985-992
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
11-2018
Author
Anna-Maija Tolppanen
Miia Tiihonen
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Piia Lavikainen
Jari Tiihonen
Sirpa Hartikainen
Author Affiliation
School of Pharmacy, University of Eastern Finland, PL 1627, 70211, Kuopio, Finland. anna-maija.tolppanen@uef.fi.
Source
Drugs Aging. 2018 11; 35(11):985-992
Date
11-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Aged, 80 and over
Alzheimer Disease - psychology
Cognitive Dysfunction - etiology
Cohort Studies
Estrogens - administration & dosage
Female
Finland - epidemiology
Humans
Independent living
Middle Aged
Prevalence
Abstract
It is unknown whether cognitive status or diagnosed cognitive decline affects estrogen use.
We assessed how common systemic estrogen use was among community-dwellers with Alzheimer's disease (AD) and a matched comparison cohort without AD.
This study included an exposure-matched cohort of all Finnish community-dwelling women who received a clinically verified diagnosis of AD in 2005-2011 (N?=?46,116; index cases) and an equally sized matched comparison cohort without AD. Follow-up began on the matching date (date of the AD diagnosis of the index case). Data on systemic estrogen use were obtained from the prescription register. Use initiation and discontinuation were assessed.
Altogether 3.1% of women with AD and 4.3% of women without AD used estrogen during the follow-up period. Only?
PubMed ID
30317535 View in PubMed
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7 records – page 1 of 1.