Antidepressant Use and Progression of Mild to Moderate Alzheimer's Disease: Results from the European ICTUS Cohort.

OBJECTIVES: Neuropsychiatric symptoms (NPS) are a core and troubling feature among patients with Alzheimer disease (AD). Because of growing safety warnings against antipsychotics, the use of antidepressants (ATD) in AD has increased extensively. We investigated the potential long-term associations between ATD exposure and functional and cognitive progression in patients with mild to moderate AD. DESIGN: Two-year prospective multicenter cohort ICTUS (Impact of Cholinergic Treatment USe) study with biannual assessments. SETTING: Twenty-nine memory clinics from 12 European countries. PARTICIPANTS: Community-dwelling patients with mild to moderate AD. METHODS: Global cognitive function was measured using the Mini Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog). Functional impairment was measured using the Activities of Daily Living (ADL). Assessments were performed biannually for 2 years. Antidepressant exposure was defined by an ATD prescription for a minimum period of 6 months. Linear mixed models were used to study the associations between ATD exposure and cognitive and functional progression. RESULTS: Antidepressant exposure was not associated with cognitive decline [MMSE: ß-coefficients of the linear mixed models (Coef) = 0.06, 95% confidence interval (CI) -0.65 to 0.76, P = .87; ADAS-Cog: Coef = -13.9, 95% CI -34.80 to 7.03, P = .19] or with functional decline (ADL: Coef = -0.05, 95% CI -0.21 to 0.09, P = .48) at 2-year follow-up. Antipsychotic exposure at baseline was associated with a greater functional decline in the ADL score (Coef = -0.39, 95% CI - 0.68 to 0.10, P < .01). CONCLUSIONS AND IMPLICATIONS: Antidepressant exposure was not associated with a faster rate of cognitive or functional decline in patients with mild to moderate AD. Antidepressants might be appropriate alternatives to antipsychotics in the management of NPS in mild to moderate AD.

Impact of a Pharmacist-included Mobile Geriatrics team intervention on potentially inappropriate drug prescribing: protocol for a prospective feasibility study (PharMoG study).

INTRODUCTION: Research has shown that potentially inappropriate drug prescription (PIDP) is highly prevalent in older people. The presence of PIDPs is associated with adverse health outcomes. This study aims to evaluate the impact of a PHARmacist-included MObile Geriatrics (PharMoG) team intervention on PIDPs in older patients hospitalised in the medical, surgical and emergency departments of a university hospital. METHODS AND ANALYSIS: The PharMoG study is a prospective, interventional, single-centre feasibility study describing the impact of a PharMoG team on PIDPs in older hospitalised patients. Pharmacist intervention will be a treatment optimisation (clinical medication review) based on a combination of explicit and implicit criteria to detect PIDPs. The primary outcome is the acceptance rate of the mobile team's proposed treatment optimisations related to PIDPs, measured at the patient's discharge from the department. This pharmacist will work in cooperation with the physician of the mobile geriatric team. After the intervention of the mobile geriatric team, the proposals for improving therapy will be sent to the hospital medical team caring for the patient and to the patient's attending physician. The patient will be followed for 3 months after discharge from the hospital. ETHICS AND DISSEMINATION: This study was approved by the South-West and Overseas Territories II Ethics Committee. Oral consent must be obtained prior to participation, either from the patient or from the patient's representative (trusted person and/or a family member). The results will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04151797.

Depression in People With Dementia and Caregiver Outcomes: Results From the European Right Time Place Care Study.

OBJECTIVE: To investigate the cross-sectional associations between depression in people with dementia and both caregiver burden and quality of life in 8 European countries, and to test these associations compared with the presence of other neuropsychiatric symptoms. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: In total, 1223 dyads comprised of informal caregivers and people with dementia living in a community-dwelling setting, recruited from the Right Time Place Care study, a cohort survey from 8 European countries. MEASURES: To test the associations between depression (according to the Cornell Scale for Depression in Dementia) and informal caregiver burden (defined by the Zarit scale and hours of supervision in terms of Resource Utilization in Dementia), distress (defined by the Neuropsychiatric Inventory Questionnaire distress score), and quality of life (according to the visual analogue scale and 12-item General Health Questionnaire). RESULTS: Linear regressions showed an association between depression and main outcomes (Zarit scale: ß 3.7; P = .001; hours of supervision: ß 1.7; P = .004; Neuropsychiatric Inventory Questionnaire distress score: ß 1.2; P = .002). A similar association was found concerning psychological and overall well-being (12-item General Health Questionnaire: ß 1.8; P < .001; Euroqol Visual Analogue Scale: ß -4.1; P = .003). Both associations remained significant despite the presence of other NPS and after adjusting for confounders. CONCLUSIONS AND IMPLICATIONS: Further studies are needed to assess whether providing tailored strategies for optimizing diagnosis and managing of depression in people with dementia might improve caregiver quality of life and reduce their burden in the community-dwelling setting.

Antidepressants in nursing homes for dependent older patients: the cross-sectional associations of institutional factors with prescription conformance.

PURPOSE: Depression is diagnosed in approximately 40% of the nursing home (NH) residents, but the pertinence of the high use of antidepressants is often criticized. We aimed at determining the proportion of non-conforming antidepressant prescriptions among NH residents and the associated institutional and demographic factors. METHODS: Cross-sectional study of 2651 residents in 175 French NH participating in the IQUARE study (Impact of a QUAlity process on the development of practices and the functional decline of NH REsidents) and treated with antidepressants. Diagnosis of depression was obtained from the medical records. Antidepressant treatments were identified on the prescriptions and their conformance was analyzed in light of the international practice guidelines (i.e., indication, drug class, duplication, and monitoring). RESULTS: A total of 1017 residents (38.4%) had a non-conforming prescription. Availability of a list of recommended medications for older patients (OR = 1.39, 95% CI [1.15; 1.68], p < 0.001) and regular intervention by a psychiatrist/psychiatric nurse in the facility (OR = 1.50, 95% CI [1.26; 1.77], p < 0.001) were associated with better antidepressant conformance. Women (OR = 0.76, 95% CI [0.61; 0.93], p < 0.05) and residents on multiple drugs (OR = 0.64, 95% CI [0.50; 0.80], p < 0.001) were at higher risk for non-conforming antidepressant prescription. A history of dementia (OR = 1.54, 95% CI [1.29; 1.84], p < 0.001), co-prescription of neuroleptics (OR = 4.23, 95% CI [2.20; 8.12], p < 0.001), and a known date of psychotropic initiation (OR = 2.58, 95% CI [2.10; 3.16], p < 0.001) were associated with better antidepressant conformance. CONCLUSIONS: Our results suggest that a "quality process" by the NH combining accessible psychiatric care in facilities, pharmacological monitoring, and prescription improvement actions might optimize antidepressant prescribing for residents.