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Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland

  • Marja-Liisa Laitinen (a1) (a2), J. Simon Bell (a1) (a3) (a4), Piia Lavikainen (a1), Eija Lönnroos (a1) (a2), Raimo Sulkava (a2) (a5) and Sirpa Hartikainen (a1) (a3) (a6)...

Abstract

Background: Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.

Methods: The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.

Results: The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91–6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions – 67.8% in the AD and 62.9% in the non-AD group – were generated in primary care situations.

Conclusion: One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.

Copyright

Corresponding author

Correspondence should be addressed to: Marja-Liisa Laitinen, MD, Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland. Phone: +358445361308; Fax +35817162424. Email: marja-liisa.laitinen@uef.fi.

References

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Aguera-Ortiz, L., Frank-Garcia, A., Gil, P., Moreno, A. and fiveE Study, Group (2010). Clinical progression of moderate-to-severe Alzheimer's disease and caregiver burden: a 12-month multicenter prospective observational study. International Psychogeriatrics, 22, 12651279. doi: 10.1017/S104161021000150X.
Ålander, J., Lönnroos, E., Hartikainen, S. and Klaukka, T. (2006). Nationwide use of medicines for Alzheimer's disease by community-dwelling persons in Finland. Journal of the American Geriatrics Society, 54, 557558. doi: 10.1111/j.1532-5415.2006.00643_10.x.
Alanen, H. M. et al. (2008). Use of antipsychotic medications in older home-care patients. Report from nine European countries. Aging: Clinical and Experimental Research, 20, 260265.
Alexopoulos, G. S., Streim, J., Carpenter, D., Docherty, J. P. and Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients (2004). Using antipsychotic agents in older patients. Journal of Clinical Psychiatry, 65 (Suppl. 2), 599; discussion 100–102; quiz 103–104.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association.
APA Work Group on Alzheimer's Disease and Other Dementias (2007). American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. 2nd edition. American Journal of Psychiatry, 164, 556.
Ballard, C. et al. (2008). A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Medicine, 5, e76. doi: 10.1371/journal.pmed.0050076.
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151157. doi: 10.1016/S1474-4422(08)70295-3.
Bell, J. S., Laitinen, M-L., Lavikainen, P., Lönnroos, E., Uosukainen, H. and Hartikainen, S. (2011). Use of strong opioids among community-dwelling persons with and without Alzheimer's disease in Finland. Pain, 15, 543547. doi: 10.1016/j.pain.2010.11.003.
Bishara, D., Taylor, D., Howard, R. J. and Abdel-Tawab, R. (2009). Expert opinion on the management of behavioural and psychological symptoms of dementia (BPSD) and investigation into prescribing practices in the UK. International Journal of Geriatric Psychiatry, 24, 944954. doi: 10.1002/gps.2200.
Brown, C. S., Markowitz, J. S., Moore, T. R. and Parker, N. G. (1999). Atypical antipsychotics: Part II: Adverse effects, drug interactions, and costs. Annals of Pharmacotherapy, 33, 210217.
Desplenter, F., Caenen, C., Meelberghs, J., Hartikainen, S., Sulkava, R. and Bell, J. S. (2011). Change in psychotropic drug use among community-dwelling people aged 75 years and older in Finland: repeated cross-sectional population studies. International Psychogeriatrics. Epublished ahead of print. doi: 10.1017/S1041610211000718.
Finnish Medicines Agency (2011). Drug Consumption in Years 2007–2010. Available at: http://www.fimea.fi/laaketieto/kulutustiedot; last accessed 17 June 2011 [in Finnish].
Ganjavi, H. et al. , (2007). Adverse drug events in cognitively impaired elderly patients. Dementia and Geriatric Cognitive Disorders, 23, 395400. doi: 10.1159/000101454.
Gill, S. S. et al. (2007). Antipsychotic drug use and mortality in older adults with dementia. Annals of Internal Medicine, 146, 775786.
Hartikainen, S., Rahkonen, T., Kautiainen, H. and Sulkava, R. (2003). Use of psychotropics among home-dwelling nondemented and demented elderly. International Journal of Geriatric Psychiatry, 18, 11351141. doi: 10.1002/gps.1024.
Haukka, J., Suvisaari, J., Tuulio-Henriksson, A. and Lonnqvist, J. (2007). High concordance between self-reported medication and official prescription database information. European Journal of Clinical Pharmacology, 63, 10691074. doi: 10.1007/s00228-007-0349-6.
Kales, H. C. et al. (2007). Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. American Journal of Psychiatry, 164, 15681576.
Kales, H. C. et al. (2011). Trends in antipsychotic use in dementia 1999–2007. Archives of General Psychiatry, 68, 190197.
Kennedy, J. et al. (2009). The association between class of antipsychotic and rates of hospitalization: results of a retrospective analysis of data from the 2005 Medicare current beneficiary survey. Clinical Therapeutics, 31, 29312939. doi: 10.1016/j.clinthera.2009.12.017.
Linjakumpu, T., Hartikainen, S., Klaukka, T., Koponen, H., Kivelä, S. L. and Isoaho, R. (2002). Psychotropics among the home-dwelling elderly: increasing trends. International Journal of Geriatric Psychiatry, 17, 874.
Livingston, G., Johnston, K., Katona, C., Paton, J., Lyketsos, C. G.; Old Age Task Force of the World Federation of Biological Psychiatry (2005). Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 162, 19962021. doi: 10.1176/appi.ajp.162.11.1996.
Lyketsos, C. G. et al. (2006). Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. American Journal of Geriatric Psychiatry, 14, 561573.
National Agency for Medicines and Social Insurance Institution of Finland (2006). Finnish Statistics on Medicines 2005. Helsinki: Edita Prima OY.
National Institute for Health and Clinical Excellence (2011). Dementia: Supporting People with Dementia and their Carers in Health and Social Care. Available at: http://guidance.nice.org.uk/CG42; last accessed 23 March 2011.
Pouwels, S., van Staa, T. P., Egberts, A. C., Leufkens, H. G., Cooper, C. and de Vries, F. (2009). Antipsychotic use and the risk of hip/femur fracture: a population-based case-control study. Osteoporosis International, 20, 14991506. doi: 10.1007/s00198-008-0826-5.
Rikala, M., Hartikainen, S., Sulkava, R. and Korhonen, M. J. (2010). Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly Finns: a population-based intervention study. Drugs & Aging, 27, 337349. doi: 10.2165/11315960-000000000-00000.
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 15251538. doi: 10.1056/NEJMoa061240.
van Iersel, M. B., Zuidema, S. U., Koopmans, R. T., Verhey, F. R. and Olde Rikkert, M. G. (2005). Antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs and Aging, 22, 845858.
Wang, P. S. et al. , (2005). Risk of death in elderly users of conventional vs. atypical antipsychotic medication. New England Journal of Medicine, 353, 23352341.
WHO Collaborating Centre for Drug Statistics Methodology (2011). The Anatomical Therapeutic Chemical Classification System. Available at: http://www.whocc.no; last accessed 11 January 2011.
Working Group set by the Finnish Medical Society Duodecim, the Societas Gerontologica Fennica, the Finnish Neurological Society, the Finnish Psychogeriatric Association and the Finnish Association for General Practice (2010). Current Care Guideline: Diagnosis and Medical Treatment of Memory Disorders. Available at: http://www.kaypahoito.fi; last accessed 23 March 2011.
Zheng, L. et al. (2009). Metabolic changes associated with second-generation antipsychotic use in Alzheimer's disease patients: the CATIE-AD study. American Journal of Psychiatry, 166, 583590. doi: 10.1176/appi.ajp.2008.08081218.

Keywords

Nationwide study of antipsychotic use among community-dwelling persons with Alzheimer's disease in Finland

  • Marja-Liisa Laitinen (a1) (a2), J. Simon Bell (a1) (a3) (a4), Piia Lavikainen (a1), Eija Lönnroos (a1) (a2), Raimo Sulkava (a2) (a5) and Sirpa Hartikainen (a1) (a3) (a6)...

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