Prescripción potencialmente inapropiada y polifarmacia en adultos mayores con demencia moderada y severa / Potentially inappropriate prescription and polypharmacy in older adults with dementia moderate and severe

Objetivo: Determinar la prevalencia de polifarmacia y prescripciones potencialmente inapropiadas (PPI) en pacientes mayores con demencia moderada y grave. Material y métodos: Este estudio retrospectivo transversal incluyó 180 pacientes diagnosticados con demencia durante junio de 2018 a abril de 2019. Se analizaron variables demográficas, comorbilidades, tipo de demencia, número de fármacos prescritos y la prevalencia de prescripción inadecuada. Resultados: La edad media fue 80,5 (±7,4) años. La demencia más frecuente fue Alzheimer (50%). 150 (83%) y 90 (50%) pacientes fueron detectados con polifarmacia y PPI, respectivamente. Las PPI más frecuentes fueron: fármacos que afectan la probabilidad de caída (22%), el sistema nervioso central y cardiovascular (14%). El riesgo de PPI fue 2,29 veces mayor en aquellos con polifarmacia. Discusión: En pacientes con demencia moderada y severa la polifarmacia aumenta el riesgo de PPI, siendo ambas altamente prevalentes. Revisar constantemente la medicación en esta población es necesario para reducir los riesgos a la salud (AU)

Objective: To determine the prevalence of polypharmacy and potentially inappropriate prescriptions (PIP) in older patients with moderate and severe dementia. Methods: This retrospective, cross-sectional study included 180 patients diagnosed with dementia during June 2018 to April 2019. We analyzed demographic variables, comorbidities, type of dementia, number of drugs prescribed and the prevalence of inadequate prescription. Results: Mean age was 80.5 (±7.4) years. Alzheimer's disease was the most frequent dementia (50%). 150 (83%) and 90 (50%) patients were detected with polypharmacy and PIP, respectively. The most frequent PIP were about drugs that affect individual’s probability of falling (22%), the central nervous system and the cardiovascular system (14%). The risk of PIP was 2,29 times higher in those with polypharmacy. Discussion: Polypharmacy and PPI are highly prevalent in older adults with moderate and severe dementia. Polypharmacy increases the risk of PIP. A continuous evaluation of the medication in this population is necessary to reduce the risk of adverse events (AU)

A randomized placebo-controlled trial evaluating the effect of melatonin on sleep quality in patients with mild-moderate dementia.

BACKGROUND: Patients with dementia may suffer from poor sleep quality as well as insomnia and sleep-wake cycle alterations. OBJECTIVES: The main objective of this study was to evaluate the efficacy of melatonin in improving sleep quality. METHODS: This was a single-center randomized, double-blinded, placebo-controlled study carried out on outpatients with dementia and sleep alterations (according to Diagnostic and Statistical Manual V criteria) from January 2016 to December 2016. Patients aged 65 years or over with a diagnosis of mild-moderate dementia (Clinical Dementia Rating 1-2) were included. Patients were randomized to receive either 5 mg of melatonin or placebo every night for 8 weeks. The primary outcome was sleep quality according to the Pittsburgh Sleep Quality Index (PSQI). Secondary measurements included Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Geriatric Depression Scale and Katz and Lawton scales for functionality. RESULTS: 40 patients were included (21 in the melatonin group and 19 in the placebo group). Nine patients withdrew from the study, and data of 31 patients were analyzed (16 from the melatonin group and 15 in the placebo group). Baseline characteristics of the population were comparable. PSQI scores improved in both groups at every timepoint compared to baseline, but there were no significant differences between groups. At 8 weeks, there was no difference between groups in any of the secondary outcomes except for the sleep sub-item of the NPI, where melatonin group had lower median scores compared to placebo (1, Interquartile Range = 3, vs. 4.4, Interquartile Range = 4.6, p = 0.03). CONCLUSION: Melatonin administered nightly to older persons with dementia was not effective in improving sleep quality. Clinicaltrials.gov Identifier: NCT03066518.