Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA.

TitlePsychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA.
Publication TypeJournal Article
Year of Publication2017
AuthorsMaust, DT, Langa, KM, Blow, FC, Kales, HC
JournalInternational Journal of Geriatric Psychiatry
Volume32
Issue2
Pagination164-174
Date Published2017 Feb
ISSN Number1099-1166
KeywordsADAMS, Antidepressants, Dementia, Drug use, Older Adults, Psychiatry
Abstract

OBJECTIVE: To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia.

METHODS: Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer).

RESULTS: Of 414 participants with dementia, 41.4% were prescribed a psychotropic medication, including 84.0% of nursing home residents and 28.6% of community-dwellers. Of participants, 23.5% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use.

CONCLUSIONS: In this nationally representative sample, 41.4% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright © 2016 John Wiley & Sons, Ltd.

DOI10.1002/gps.4452
Alternate JournalInt J Geriatr Psychiatry
Citation Key8918
PubMed ID26889640
PubMed Central IDPMC4990518
Grant ListK08 AG048321 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States