Skip header and navigation

Refine By

3 records – page 1 of 1.

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
Less detail

Kynurenines as predictors of acute coronary events in the Hordaland Health Study.

https://arctichealth.org/en/permalink/ahliterature272283
Source
Int J Cardiol. 2015;189:18-24
Publication Type
Article
Date
2015
Author
Simone J P M Eussen
Per Magne Ueland
Stein E Vollset
Ottar Nygård
Øivind Midttun
Gerhard Sulo
Arve Ulvik
Klaus Meyer
Eva Ringdal Pedersen
Grethe S Tell
Source
Int J Cardiol. 2015;189:18-24
Date
2015
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - blood - mortality - physiopathology
Age Factors
Aged
Angina Pectoris - blood - mortality - physiopathology
Biomarkers - metabolism
Cohort Studies
Confidence Intervals
Female
Geriatric Assessment - methods
Health Surveys
Humans
Independent living
Kynurenine - metabolism
Male
Myocardial Infarction - blood - mortality - physiopathology
Norway
Predictive value of tests
Prognosis
Proportional Hazards Models
Prospective Studies
Risk assessment
Severity of Illness Index
Sex Factors
Statistics, nonparametric
Survival Analysis
Abstract
The kynurenine pathway, the main metabolic route of tryptophan degradation, has been related to inflammatory responses. Some of its metabolites, referred to as kynurenines, have been associated with prevalence of coronary heart disease (CHD) in cross-sectional studies. This prospective study aims to investigate whether increased concentrations of kynurenines are associated with risk of acute coronary events, defined as unstable angina pectoris, acute myocardial infarction, and/or sudden death in community-dwelling elderly.
The baseline examinations included 2819 individuals aged 71-74 years recruited into the Hordaland Health Study. Participants with known CHD at baseline were excluded from analyses. Baseline plasma concentrations of tryptophan, kynurenine, kynurenic acid, anthranilic acid, 3-hydroxykynurenine, xanthurenic acid, and 3-hydroxyanthranilic acid were measured by LC-MS/MS. During a median follow-up period of 10.8 years, with linkage to acute coronary event endpoints through the CVDNOR project, hazard ratios (HRs) for acute coronary events (n = 376) were estimated using Cox proportional hazard analyses.
After adjustment for established cardiovascular risk factors, HRs (95% CI) comparing the 4th vs 1st quartile were 1.86 (1.19-2.92) for kynurenine and 1.72 (1.19-2.49) for 3-hydroxykynurenine. Tryptophan, kynurenic acid, anthranilic acid, xanthurenic acid and 3-hydroxyanthranilic acid were not associated with acute coronary events.
Kynurenine and 3-hydroxykynurenine were associated with increased risk of acute coronary events in community-dwelling elderly without a known history of CHD. These results suggest the involvement of the kynurenine pathway in the early development of CHD, and their potential usefulness to estimate CHD risk.
PubMed ID
25885868 View in PubMed
Less detail

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
Less detail