The French translation of the dementia screening questionnaire for individuals with intellectual disabilities is a sensitive tool for screening for dementia in people with Down Syndrome.

BACKGROUND: People with Down Syndrome (DS) are at an increased risk of developing Alzheimer's Disease (AD) relatively early in life. The dementia screening questionnaire for individuals with intellectual disabilities (DSQIID) has been developed for people with intellectual disabilities and was shown to have high discriminative power to distinguish between people with and without dementia. The objective of this study was to verify if the French version of the DSQIID (DSQIID-F) had a good diagnostic specificity and to determine the optimal cut-off for screening people with DS for dementia. METHOD: This was a single-centre, retrospective, medical chart review study in people with DS aged ≥40 years. Demographics, level of intellectual disability, DSQIID-F data and clinical assessment of dementia were extracted from medical records. Sensitivity and specificity for different DSQIID-F cut-offs were calculated to determine the optimal cut-off. RESULTS: 151 people with DS were included with a median age of 51 years. The optimal DSQIID-F cut-off was 19, sensitivity was 0.940 (95 % CI: 0.830; 0.985) and specificity was 0.941 (95 % CI: 0.873; 0.975). Results were comparable to those for the English DSQIID (cut-off: 20; sensitivity: 0.92; specificity: 0.97). However, the psychometric qualities of the DSQIID-F, used for clinical follow-up, have not been verified. CONCLUSIONS: The DSQIID-F has good discriminative power and represents a useful tool to screen people with DS for dementia.

Removal of Drugs for Alzheimer's Disease from the List of Reimbursable Drugs in France: Analysis of Change in Drug Use, Disease Management and Cognition Using the National Alzheimer Data Bank (BNA).

BACKGROUND: Because of insufficient data about their benefit-risk ratio in real life, drugs used for Alzheimer's disease (AD; cholinesterase inhibitors and memantine) were withdrawn from the list of reimbursable drugs in France on 1 August 2018. OBJECTIVES: In this context, this study aimed to investigate the effects of the removal of AD drugs from the list of reimbursed drugs among patients followed in memory centres in France, in terms of prevalence and factors associated with drug discontinuation and evolution of disease management and cognition after drug discontinuation. METHODS: This is an observational study based on data from the National Alzheimer Data Bank ('Banque Nationale Alzheimer' [BNA]), which centralizes information about patients consulting in memory centres. The drug discontinuation rate was estimated among patients receiving AD drugs at the last visit before the end of reimbursement. Factors associated with drug discontinuation were investigated among sociodemographic and disease characteristics, as well as among the use of healthcare resources before the end of reimbursement. We compared the evolution of disease management (psychotropic drugs and non-pharmacological interventions) and Mini-Mental State Examination (MMSE) score during the year following the end of reimbursement among patients with a diagnosis of AD. RESULTS: Among the 19,380 patients of the study sample (62.5% females, mean age 81 years, 86.8% with a diagnosis of AD), 19.5% discontinued their treatment after the end of reimbursement. The main factors associated with drug discontinuation were the type of dementia and lower MMSE level. Compared with patients with a diagnosis of AD, those with vascular dementia were more likely to stop their treatment, whereas those with dementia with Lewy bodies were less likely to discontinue. Among patients with a diagnosis of AD, drug discontinuation was associated with increased use of psychotropic medications, especially antidepressants, and non-pharmacological interventions afterwards, but there was no difference regarding the evolution of MMSE score. CONCLUSION: This study provides real-life information about the use of AD drugs after they were withdrawn from reimbursement in France and shows that drug discontinuation was limited among patients followed in memory centres and accompanied by increased use of other healthcare resources.

Do older adults know the purpose of their medications? A survey among community-dwelling people.

PURPOSE: This study assessed the level of knowledge among community-dwelling older individuals about the purpose of medications and the characteristics that influenced that knowledge. We focused on drugs frequently used and/or often involved in iatrogenic events. METHODS: This cross-sectional survey included 2690 community-dwelling older adults, aged 68 years and above, who reported using at least one drug of interest, in the canton of Vaud, Switzerland. Participants reported drugs that they currently used and described their purpose. A good knowledge level was defined as knowledge of the exact purpose or identification of the anatomical system or organ targeted by the drug. We performed a multivariate logistic regression analysis to identify factors associated with a good knowledge level for all drugs of interest. Sampling weights were employed to provide representative estimates. RESULTS: On average, patients had good knowledge of 80.6% of the drugs reported. The highest knowledge levels were demonstrated for non-steroidal antiinflammatory drugs, antidiabetics, analgesics, and endocrinological drugs and the lowest for platelet aggregation inhibitors, minerals, anticoagulants, and other narrow therapeutic index drugs. Overall, 66% of participants had good knowledge of the purpose of all the drugs of interest. Polypharmacy and receiving help with drug management were negatively associated with good knowledge (adjusted OR4-5 drugs 0.45; 95% CI 0.29-0.71, adjusted OR≥ 6 drugs 0.20; 95% CI 0.13-0.31, and adjusted ORhelp 0.42; 95% CI 0.18-0.99). CONCLUSION: This study showed that education about drugs was lacking among patients that received multiple drugs, particularly patients that used anticoagulants and antiplatelet inhibitors.

Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality.

ABSTRACTBackground:The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people. OBJECTIVE: To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France. METHODS: The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years). RESULTS: Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11-6.16 and aOR≥10 drugs 2.69, 95% CI 1.06-6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04-6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94-5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28-4.12). CONCLUSIONS: This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.