A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer’s Disease in the US and Finland

Abstract

Aims Given the high prevalence of psychotropic medication use in people with dementia and the potential for different prescribing practices in men and women, our study aimed to investigate sex differences in psychotropic medication use in older adults with Alzheimer's disease (AD) living in the US and Finland. Methods We used data collected between 2005 and 2011 as part of the National Alzheimer's Coordinating Center (NACC) in the US, and Medication use and Alzheimer's disease (MEDALZ) cohorts in Finland. We evaluated psychotropic medication use (antidepressant, antipsychotic, anxiolytic, sedative, or hypnotic) in participants aged 65 years or older. We employed multivariable logistic regression adjusted for demographics, co-morbidities, and other medications to estimate the magnitude of the association (adjusted odds ratio [aOR] with 95% confidence intervals [CIs]) according to sex. Results We included 1099 NACC participants (502 [45.68%] men, 597 [54.32%] women), and 67,049 participants from the MEDALZ cohort (22,961 [34.24%] men, 44,088 [65.75%] women). Women were more likely than men to use psychotropic medications: US, 46.2% vs. 33.1%, p < 0.001; Finland, 45.3% vs. 36.1%, p < 0.001; aOR was 2.06 (95% CI 1.58–2.70) in the US cohort and 1.38 (95% CI 1.33–1.43) in the Finnish cohort. Similarly, of the different psychotropic medications, women were more likely to use antidepressants (aOR-US: 2.16 [1.44–3.25], Finland: 1.52 [1.45–1.58]) and anxiolytics (aOR-US: 2.16 [1.83–3.96], Finland: 1.17 [1.13-1.23]) than men. Conclusionl Older women with AD are more likely to use psychotropic medications than older men, regardless of study population and country. Approaches to mitigate psychotropic medication use need to consider different prescribing habits observed in older women vs. men with AD.

Inclusion of sex and gender in biomedical research: survey of clinical research proposed at the University of Pennsylvania

“…This practice is particularly disconcerting with respect to randomized clinical trials given the evidence that female sex is a risk factor for side effects and adverse events related to medication treatment [ 13 – 15 ]. For many chronic medical conditions, such as migraines [ 16 , 17 ], autoimmune disease [ 18 , 19 ], cardiovascular disease [ 20 , 21 ], and dementia [ 22 – 24 ], sex contributes to the prevalence, symptom presentation, and clinical course. The contribution of gender to health and healthcare is evident in the behavioral factors that contribute to risks for a disorder and the propensity to seek evaluation and intervention.…”

Psychotropic Drug-Associated Pneumonia in Older Adults

“…In Finland, 53% of persons with AD used psychotropic drugs compared with 33% of persons without AD [28]. Moga et al [43] observed that older females with AD are more likely to use psychotropic drugs than older males, both in the US and Finland.…”

The puzzle of sex, gender and Alzheimer’s disease: Why are women more often affected than men?

“…Women, including those with dementia, are more likely to be prescribed certain classes of psychotropic medications including sleep aids, which increase the risk of cognitive impairment. 57 Men may be more likely than women to receive treatment with cholinesterase inhibitors, currently the main medication class used in the specific treatment of AD. 58 These prescribing differences may be due to gender differences in the care of women versus men by physicians.…”

“…However, this possible gender difference in patterns of medication use is complicated by sex differences in drug metabolism, 59,60 and thus, these two together may render women more susceptible than men to cognitive impairment. 57 Also, some medications in current and future use (including some antidepressants and mood stabilizers) have epigenetic mechanisms of action which may differ between the sexes. 33 This may in turn account for sex differences in treatment response which will be missed if drug studies do not specifically include both women and men and target specific investigation of sex differences.…”