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2.
Medicine (Baltimore) ; 99(33): e21711, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872049

RESUMO

BACKGROUND: This study will investigate the effects of Spore Powder of Ganoderma Lucidum (SPGL) on CaSR and apoptosis-related proteins (ARP) in hippocampus tissue of epilepsy following dementia. METHODS: This study will retrieve all potential studies from both electronic databases (Cochrane Library, EMBASE, MEDLINE, CINAHL, AMED, and CNKI) and other literature sources to assess the effects of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. We will search all literature sources from the inception to the present. All eligible case-control studies will be included in this study. Two authors will independently carry out literature selection, data collection, and study quality evaluation. Any divergence will be resolved by another author through discussion. RevMan 5.3 software will be employed for data analysis. RESULTS: This study will summarize existing evidence to assess the effects of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. CONCLUSIONS: The findings of this study may provide helpful evidence of SPGL on CaSR and ARP in hippocampus tissue of epilepsy following dementia. SYSTEMATIC REVIEW REGISTRATION: INPLASY202070041.


Assuntos
Demência/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Epilepsia/tratamento farmacológico , Hipocampo/efeitos dos fármacos , Reishi , Animais , Demência/complicações , Medicamentos de Ervas Chinesas/farmacologia , Epilepsia/etiologia , Hipocampo/metabolismo , Receptores de Detecção de Cálcio/metabolismo , Revisões Sistemáticas como Assunto
3.
Artigo em Inglês | MEDLINE | ID: mdl-32872121

RESUMO

Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The study population was 275,005 elderly patients aged ≥65 years old, selected from the longitudinal health insurance database (LHID) in 2016. Among all the elderly patients, about 60% had received anticholinergic medication at least once. Furthermore, the study selected elderly patients who had not been diagnosed with pneumonia and had not received any anticholinergic drugs in the past year in order to evaluate the correlation between pneumonia and anticholinergic drugs. The study excluded elderly patients who died or had received related drugs of incident pneumonia during the study period and selected elderly patients receiving anticholinergic drugs as the case group. Propensity score matching (PSM) on a 1:1 scale was used to match elderly patients that were not receiving any anticholinergic drugs as the control group, resulting in a final sample of 32,215 patients receiving anticholinergic drugs and 32,215 patients not receiving any anticholinergic drugs. Conditional logistic regression was used to estimate the association between anticholinergic drugs and pneumonia after controlling for potential confounders. Compared with patients not receiving anticholinergic drugs, the adjusted odds ratio of patients receiving anticholinergic drugs was 1.33 (95% confidence interval: 1.18 to 1.49). Anticholinergic medication is common among elderly patients in Taiwan. Elderly patients receiving anticholinergic drugs may increase their risk of incident pneumonia. The safety of anticholinergic drugs in the elderly should be of concern in Taiwan.


Assuntos
Antagonistas Colinérgicos/efeitos adversos , Demência/tratamento farmacológico , Pneumonia/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Prescrição Inadequada , Masculino , Farmacoepidemiologia , Pneumonia/epidemiologia , Vigilância da População , Lista de Medicamentos Potencialmente Inapropriados , Prevalência , Taiwan/epidemiologia
5.
J Clin Psychiatry ; 81(4)2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32526104

RESUMO

OBJECTIVE: Antipsychotic drugs are known to increase mortality among patients with dementia. Many patients receive concomitant treatment with other psychotropic agents. The aim of this retrospective cohort study was to investigate the impact of benzodiazepines and antidepressants on the risk of death in patients with dementia initiating antipsychotic drug treatment. METHODS: Nationwide registry data on all incident dementia cases among individuals aged 65 years and older in Denmark between 2009 and 2013 for which antipsychotic treatment was initiated were used. The 180-day mortality was evaluated by crude and adjusted hazard ratios (HRs, including adjustment for somatic and psychiatric comorbidity, other prescription drugs, nursing home residency, and time since diagnosis), comparing periods of antipsychotic treatment with periods of concomitant treatment with benzodiazepines or antidepressants. RESULTS: Among 41,494 incident dementia cases, antipsychotic treatment was initiated for 10,291 (24.8%). After 3,140 people were excluded due to recent antipsychotic drug use or hospitalization, 7,151 people were included in the analysis. The total follow-up time during current antipsychotic treatment was 1,146 person-years, and 831 died during antipsychotic treatment. Compared with antipsychotic treatment alone, the risk of death increased during antipsychotic treatment in combination with benzodiazepines (adjusted HR = 2.19; 95% CI, 1.83-2.63), while there was a decreased risk of death during antipsychotic treatment in combination with antidepressants (adjusted HR = 0.61; 95% CI, 0.50-0.74). CONCLUSIONS: The diverse impact of concomitant use of benzodiazepines and antidepressants on mortality may be due to a direct drug-related effect. Alternatively, the findings could reflect differential mortality associated with different indications for therapy. Although the results cannot prove causality, and there may be residual confounding, clinicians should be cautious when considering the combination of antipsychotics and benzodiazepines in patients with dementia.


Assuntos
Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Demência/mortalidade , Quimioterapia Combinada/mortalidade , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Demência/tratamento farmacológico , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
6.
Arch Gerontol Geriatr ; 89: 104091, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413690

RESUMO

INTRODUCTION: The neuroprotective effect of valproic acid has been observed in the animal models of neurodegeneration, which suggests it as a potential candidate for clinical trials. In this paper, we aimed to systematically analyze the efficacy and safety of valproic acid in the treatment of dementia. METHODS: We searched the electronic databases PubMed, EMBASE, CINAHL, Cochrane Library and China National Knowledge Infrastructure until March 2020 for the eligible randomized controlled trials, as well as the unpublished and ongoing trials. We pooled the results using a random-effects model. RESULTS: We included seven studies with 770 randomized patients with dementia, which compared valproic acid with placebo. Indeed, there were no significant differences found in the scores of Mini-mental State Examination, Cohen-Mansfield Agitation Inventory and number of patients with adverse events. Valproic acid is generally well-tolerated in patients with dementia, even in long-term therapy for 24 months. CONCLUSION: Insufficient evidences are found to support valproic acid in the treatment of dementia for cognitive, psychiatric symptoms or disease-modifying. The anticipations for a success in the trial of valproic acid for dementia in the future look not optimistic based on the available evidence.


Assuntos
Demência , Inibidores Enzimáticos , Ácido Valproico , Demência/tratamento farmacológico , Inibidores Enzimáticos/efeitos adversos , Humanos , Agitação Psicomotora , Ácido Valproico/efeitos adversos
8.
JAMA Netw Open ; 3(4): e203630, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32343351

RESUMO

Importance: Atypical antipsychotics (AAPs) are often used off-label to manage dementia-associated neuropsychiatric symptoms. In 2005, the US Food and Drug Administration (FDA) issued a boxed warning for the use of AAPs in elderly patients. The long-term association of this warning with health outcomes is unknown to date. Objective: To assess the long-term association of the 2005 FDA boxed warning on AAPs with psychiatric medication and opioid use, health events, and quality of life among elderly individuals with dementia. Design, Setting, and Participants: For this cross-sectional study, data were analyzed from the household component of the Medical Expenditure Panel Survey (MEPS), the National Ambulatory Medical Care Survey (NAMCS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) fielded between January 1, 1996, and December 31, 2014. This interrupted time-series analysis applied to 3-year moving means derived from the 1996-2014 MEPS, NAMCS, and NHAMCS. All survey respondents included in this analysis were 65 years or older and had dementia. Data analysis was performed from December 1, 2017, to March 15, 2018. Exposures: The 2005 FDA boxed warning on AAPs. Main Outcomes and Measures: Use of psychiatric medications and opioids, prevalence of cerebrovascular and cardiovascular events, prevalence of falls and/or fractures, 2-year mortality, and health-related quality of life assessed by the Medical Outcomes Study 12-Item Short-Form Health Survey scores. Results: A total of 2430 (MEPS) and 5490 (NAMCS and NHAMCS) respondents were identified, corresponding to weighted populations of 22 996 526 (MEPS) and 65 502 344 (NAMCS and NHAMCS) noninstitutionalized elderly individuals with dementia (mean [SD] age, 81.06 [1.13] years; 63.1% female). In the MEPS sample, compared with before 2005, AAP use (from an annual slope of 0.99 to -0.18 percentage points), cerebrovascular events (0.75 to -0.50 percentage points), and falls and/or fractures (-1.72 to -0.40 percentage points) decreased and opioid use (0.04 to 1.29 percentage points), antiepileptic use (-0.42 to 1.21 percentage points), cardiovascular events (-0.13 to 1.30 percentage points), and 2-year mortality risk (-0.68 to 0.18 percentage points) increased. Health-related quality of life remained relatively unchanged. The NAMCS and NHAMCS sample yielded similar findings. Conclusions and Relevance: These data suggest that the 2005 FDA boxed warning was associated with some unintended negative patient outcomes.


Assuntos
Antipsicóticos/efeitos adversos , Demência/tratamento farmacológico , Rotulagem de Medicamentos , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/administração & dosagem , Estudos Transversais , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , United States Food and Drug Administration
9.
Med Clin North Am ; 104(3): 471-489, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312410

RESUMO

The purpose of this article is to present evidence on the efficacy and safety of medical cannabis as a therapy for symptom management in palliative care. This article provides an overview of the evidence on the risks and benefits of using medical cannabis for the indications of chronic pain, cancer-related pain, cancer cachexia, dementia, and Alzheimer's disease. Currently, there is insufficient evidence to determine the effectiveness and safety of cannabinoids for most reviewed indications, with the exception of chronic pain. Future research is required before palliative care clinicians can make evidence-based decisions on the integration of medical cannabis as adjunct therapies.


Assuntos
Canabinoides/uso terapêutico , Dor Crônica/tratamento farmacológico , Maconha Medicinal/uso terapêutico , Manejo da Dor/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/tratamento farmacológico , Caquexia/tratamento farmacológico , Dor do Câncer/tratamento farmacológico , Canabinoides/efeitos adversos , Demência/tratamento farmacológico , Humanos , Maconha Medicinal/efeitos adversos , Metanálise como Assunto , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Manejo da Dor/tendências , Cuidados Paliativos/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
BMC Health Serv Res ; 20(1): 157, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122341

RESUMO

BACKGROUND: People living with dementia in care homes frequently exhibit "behaviour that challenges". Anti-psychotics are used to treat such behaviour, but are associated with significant morbidity. This study researched the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. This paper focusses on the feasibility of measuring clinical outcomes and intervention costs. METHODS: People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour. Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory). Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated. RESULTS: Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected). CONCLUSIONS: It is feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures. TRIAL REGISTRATION: ISRCTN58330068. Retrospectively registered, 15 October 2017.


Assuntos
Medicina do Comportamento/economia , Demência/tratamento farmacológico , Demência/psicologia , Assistência Farmacêutica/economia , Psicotrópicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Revisão de Uso de Medicamentos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Casas de Saúde , Resultado do Tratamento , Reino Unido
13.
Int J Clin Pharmacol Ther ; 58(5): 247-253, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32213286

RESUMO

BACKGROUND: There is a lack of studies investigating the role of physicians with regard to persistence among dementia patients. OBJECTIVE: The aim was to analyze the rate of persistence with antidementia medication in Germany and the UK by focusing on the role of the treating physician. MATERIALS AND METHODS: Dementia patients who had received at least 1 prescription for antidementia drugs in 240 general practices in Germany and 73 general practices in the UK between January 2013 and December 2016 were included. Persistence was defined as the time between therapy initiation and therapy discontinuation, the latter being defined as a gap of at least 90 days without antidementia therapy. The prevalence of persistent patients per practice was also estimated. High practice persistence was defined as > 60% of patients completing at least 12 months of therapy. RESULTS: A total of 3,863 patients in Germany and 3,342 patients in the UK were analyzed. In Germany, 55.2% of patients were continuing therapy after 12 months, while the figure in the UK was 80.2%. The proportion of patients with a persistence of at least 12 months per practice ranged from 0 to 80% in Germany and from 0 to 85% in the UK. The prevalence of practices with good persistence was lower in Germany than in the UK (9.6 versus 54.8%). CONCLUSION: Physicians play an important role with respect to the persistence of the dementia patients they treat. Further studies are needed to better understand the role of physicians of other specialties in patients' adherence.


Assuntos
Demência/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Papel do Médico , Alemanha , Humanos , Estudos Retrospectivos , Reino Unido
14.
Inf. psiquiátr ; (239): 83-90, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192466

RESUMO

La depresión (incluida la depresión del anciano) y la demencia plantean desafíos considerables para los pacientes, sus familias, los profesionales de la salud/sociales y toda la sociedad. Esto se debe, en parte, a la complejidad de las relaciones entre estas dos condiciones clínicas. Por un lado, la depresión es a menudo una consecuencia de la demencia (ya sea originada como una reacción psicológica a las pérdidas asociadas al avanzo de la demencia, o como una expresión del proceso orgánico en sí). Por otro lado, además de que la depresión pue-de ser un pródromo de demencia, la mayoría de los hallazgos sugieren un mayor riesgo de desarrollar demencia en personas con depresión. En cualquier caso, la ver-dad es que la depresión y la demencia a menudo coinciden clínicamente, independientemente de la dirección o incluso de la hipótesis de causalidad. Aunque la evidencia sobre la naturaleza y la fuerza de sus asociaciones no es del todo consistente, los vínculos biológicos entre la depresión y la demencia probablemente implican vías nerviosas, vasculares e inflamatorias compartidas


Depression (including late-life depression) and dementia pose considerable challenges for patients, their families, health/social care professionals and the whole society. This is due, in part, to the complexity of relationships between the two conditions. On one hand, depression is often a consequence of dementia (either originated as a psychological reaction to the losses of dementia, or as an expression of the organic process itself). On the other hand, besides that depression may be a prodrome of de-mentia, most findings suggest an increased risk for developing dementia in individuals with depression. Overall, depression and dementia often coincide clinically regard-less of the direction or even assumption of causality. Although the evidence about the nature and strength of their associations is not entirely consistent, biological links between depression and dementia probably in-volve shared nervous, vascular and inflammatory pathways


Assuntos
Humanos , Depressão/complicações , Demência/complicações , Depressão/epidemiologia , Demência/epidemiologia , Afeto , Transtornos Psicóticos Afetivos/psicologia , Diagnóstico Diferencial , Depressão/tratamento farmacológico , Demência/tratamento farmacológico
15.
Artigo em Alemão | MEDLINE | ID: mdl-32185450

RESUMO

BACKGROUND: Dementias are among the most feared diseases and pose a threat to social and healthcare systems in aging societies. A cure for Alzheimer's or other dementias will not be achieved in the coming years, which makes prevention of cognitive decline and dementia a priority for research and patient-related services. AIM: Summary of evidence for drug and other compound-related prevention of cognitive decline and dementia. MATERIAL AND METHODS: Literature review of epidemiological evidence and clinical trials of antidementia drugs, anti-amyloid drugs under development, nonsteroidal anti-inflammatory drugs, statins, hormone replacement therapy, lithium, ginkgo biloba, and Fortasyn Connect. RESULTS: There is evidence for effects on single endpoints and subgroups for some of the reviewed compounds, but there is no consistent evidence for efficacy. DISCUSSION: There is no sufficient evidence to provide any specific or general recommendation for drug- or compound-related prevention of cognitive decline or dementia. It needs to be recognized that prevention trials on cognitive decline in aging and dementia require large numbers of participants and long follow-up times, which create major challenges with regard to conducting and financing such trials. The current state of evidence also supports the potential role of nonpharmacological approaches in dementia prevention.


Assuntos
Doença de Alzheimer/tratamento farmacológico , Transtornos Cognitivos/tratamento farmacológico , Demência/tratamento farmacológico , Ginkgo biloba , Nootrópicos/uso terapêutico , Alemanha , Humanos
17.
Eur J Med Chem ; 191: 112149, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32105980

RESUMO

Patients suffering from dementia experience cognitive deficits and 90% of them show non-cognitive behavioral and psychological symptoms of dementia (BPSD). The spectrum of BPSD includes agitation, depression, anxiety and psychosis. Antipsychotics, e.g. quetiapine, have been commonly used off-label to control the burdensome symptoms, though they cause serious side effects and further cognitive impairment. Therefore, the development of targeted therapy for BPSD, suitable for elderly patients, remains relevant. A multitarget-directed ligand, acting on serotonin 5-HT2A and dopamine D2 receptors (R) and thus exerting anti-aggressive and antipsychotic activity, as well as on 5-HT6Rs and 5-HT7Rs (potential pro-cognitive, antidepressant and anxiolytic activity), poses a promising strategy for the treatment of BPSD. Antitargeting muscarinic M3R and hERG channel is expected to reduce the risk of side effects. We obtained a series of stereoisomeric compounds by combining 6-fluoro-1,2-benzoxazole moiety and arylsulfonamide fragment through pyrrolidin-1-yl-propyl linker. N-[(3R)-1-[3-(6-fluoro-1,2-benzoxazol-3-yl)propyl]pyrrolidin-3-yl]-1-benzothiophene-2-sulfonamide showed a substantial affinity for the targets of interest (pKi = 8.32-9.35) and no significant interaction with the antitargets. Functional studies revealed its antagonist efficacy (pKB = 7.41-9.03). The lead compound showed a promising profile of antipsychotic-like activity in amphetamine- and MK-801-induced hyperlocomotion (MED = 2.5 mg/kg), antidepressant-like, as well as anxiolytic-like activity in mice (MED = 0.312 and 1.25 mg/kg in the forced swim and four-plate tests, respectively). Notably, the novel compound didn't affect spontaneous locomotor activity, nor induced catalepsy or memory deficits (step-through passive avoidance test) in therapeutically relevant doses, which proved its benign safety profile. The overall pharmacological characteristics of the lead compound outperformed the reference drug quetiapine, making it a promising option for evaluation in the treatment of BPSD.


Assuntos
Antipsicóticos/farmacologia , Benzoxazóis/uso terapêutico , Demência/tratamento farmacológico , Animais , Antipsicóticos/síntese química , Antipsicóticos/química , Comportamento Animal/efeitos dos fármacos , Benzoxazóis/síntese química , Benzoxazóis/química , Demência/induzido quimicamente , Demência/psicologia , Maleato de Dizocilpina , Relação Dose-Resposta a Droga , Canais de Potássio Éter-A-Go-Go/antagonistas & inibidores , Canais de Potássio Éter-A-Go-Go/metabolismo , Humanos , Masculino , Camundongos , Modelos Moleculares , Estrutura Molecular , Relação Estrutura-Atividade
19.
Biomed Res Int ; 2020: 1704879, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32090069

RESUMO

Background: Late onset depression (LOD) often occurs in the context of vascular disease and may be associated with risk of dementia. Aspirin is widely used to reduce the risk of cardiovascular disease and stroke. However, its role in patients with LOD and risk of dementia remains inconclusive. Materials and Methods. A population-based study was conducted using data from National Health Insurance of Taiwan during 1996-2009. Patients fulfil diagnostic criteria for LOD with or without subsequent dementia (incident dementia) and among whom users of aspirin (75 mg daily for at least 6 months) were identified. The time-dependent Cox proportional hazards model was applied for multivariate analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matching patients. Cumulative incidence of incident dementia after diagnosis of LOD was calculated by Kaplan-Meier Method. Results: A total of 6028 (13.4%) and 40,411 (86.6%) patients were defined as, with and without diagnosis of LOD, among whom 2,424 (41.9%) were aspirin users. Patients with LOD had more comorbidities such as cardiovascular diseases, diabetes, and hypertension comparing to those without LOD. Among patients with LOD, aspirin users had lower incidence of subsequent incident dementia than non-users (Hazard Ratio = 0.734, 95% CI 0.641-0.841, p < 0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (p < 0.001). After matching aspirin users with non-users by propensity scores-matching method, the cumulative incidence of incident dementia was significantly lower in aspirin users of LOD patients (. Conclusions: Aspirin may be associated with a lower risk of incident dementia in patients with LOD. This beneficial effect of aspirin in LOD patients needs validation in prospective clinical trials and our results should be interpreted with caution.


Assuntos
Aspirina/uso terapêutico , Demência/tratamento farmacológico , Demência/epidemiologia , Depressão/complicações , Idade de Início , Idoso , Estudos de Coortes , Demência/etiologia , Feminino , Humanos , Incidência , Masculino , Pontuação de Propensão , Fatores de Risco
20.
Int J Geriatr Psychiatry ; 35(6): 640-649, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32100308

RESUMO

OBJECTIVES: Psychotropic medication is commonly used among people with dementia (PWD), but it shows modest efficacy and it has been associated with severe adverse events. Hospitalizations are an opportunity for medication management as well as treatment recommendations for outpatient physicians. The aim of this study was to asses factors associated with new use of psychotropic medication after hospitalization among PWD. METHODS: We conducted a retrospective dynamic cohort study from 2004 to 2015 using claims data from a German health insurance company. PWD were identified by an algorithm that included ICD-10 diagnosis and diagnostic measures. The medication classes included were antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication. The assessment period was up to 30 days after discharge from the hospital across four hospitalizations. RESULTS: The main predictors for new use of psychotropic medication were similar across medication classes. Neuropsychiatric symptoms (NPS) and the need of care were associated with higher odds of new use of antidepressants, antipsychotics, and anxiolytics or hypnotics/sedatives. A hospital stay due to dementia was an independent predictor for new use across medication classes as well. Delirium increased the odds for new use of antipsychotics and anxiolytics or hypnotics/sedatives. CONCLUSIONS: Factors associated with new use of psychotropic medication included delirium, NPS, and the need of care in PWD. The findings highlight the need for preventive interventions and non-medical treatment options in regards to delirium and NPS as well as for a more intensive use of screening tools for inappropriate medication use among PWD. Key points The percentage of new users was 1.8%, 7.1%, 2.1%, and 2.5% across hospitalizations for antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication, respectively. 83.0%, 61.9%, 56.9%, and 88.1% of new users received antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication for more than 6 weeks. Delirium and neuropsychiatric symptoms were associated with significantly increased odds of new psychotropic medication use. Hospital stays due to dementia and the need of care were predictors for new use of psychotropic medication.


Assuntos
Demência , Psicotrópicos , Estudos de Coortes , Demência/tratamento farmacológico , Hospitalização , Humanos , Psicotrópicos/uso terapêutico , Estudos Retrospectivos
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