Central Nervous System Drug Consumption Depending on the Time between Symptom Onset and the Diagnosis of Alzheimer’s Disease: An Analysis by the Registry of Dementias of Girona

Abstract

Aims: To describe central nervous system (CNS) drug consumption patterns depending on the time to diagnosis of Alzheimer’s disease (AD), and to check whether the cases diagnosed later are associated with greater severity and consuming more CNS drugs. Methods: Cross-sectional study using 952 cases of the Registry of Dementias of Girona. A binary logistic regression was used to detect variables associated with the use of CNS drugs depending on the time to diagnosis. Results: CNS drugs were consumed by 95.8% of the AD patients. Only antipsychotics presented a statistically significant increase in the frequency of prescription to patients with longer time elapsed from symptom onset to AD diagnosis. Conclusion: Longer time elapsed from the onset of symptoms to the diagnosis resulted in increased probability of antipsychotic consumption.

Differences in Drug Therapy between Dementia Disorders in the Swedish Dementia Registry: A Nationwide Study of over 7,000 Patients

“…Antipsychotics are often used to treat neuropsychiatric symptoms, although these drugs should be prescribed restrictively [19]. Accordingly, our data showed that institutionalized dementia patients were more likely to use antipsychotics [41,42], after adjustment for age, sex, living alone, MMSE score, overall co-morbidity and dementia disorder. There have been concerns about a possible over-prescribing of these drugs in institutions and a large variation between nursing homes has been observed [43].…”

“…Frail elderly people are sensitive to the adverse effects of these drugs, which can even cause increased mortality in this vulnerable group [20,21]. The overall use of antipsychotics in patients with AD in this study was quite low (4-5%) [41], probably due to the mild stage of disease, but maybe also because of an increased awareness of restrictive prescribing of these drugs. DLB was strongly associated with the use of antipsychotics.…”

Use of psychotropic medications in relation to neuropsychiatric symptoms, cognition and functional performance in Alzheimer's disease over a three-year period: Kuopio ALSOVA study

“…Psychotropic medication use may reflect a failure to identify AD in the prodromal stages. This was the conclusion of Calvó-Perxas et al (2012) who reported that the time from symptom onset to AD diagnosis was associated with the probability of antipsychotic use. In our study, the odds of using antipsychotics over the three-year follow-up was 100% higher in persons with mild AD at baseline compared to those with very mild AD, although this result was not statistically significant.…”

Neuroleptic Equivalent Dose Differences and Behavioral and Psychological Symptoms of Dementia

“…An adequate management of BPSD still represents a major challenge since, on the one hand, no treatment is currently approved for this indication and, on the other, several harmful side effects significantly limit the use of available drugs, especially neuroleptics. Conventional and atypical neuroleptics, in fact, are those most commonly used, albeit they are employed off-label [1,2], and several reports and FDA warnings indicate increased mortality and an increased rate of cerebrovascular accidents, besides prolongation of the QT interval with increased risk of torsade de pointes [3]. In order to sort out reliable data on the actual risks for demented patients, some authors have recently introduced the concept of chlorpromazine or haloperidol equivalents (CE and HE, respectively, at 100 mg and 2 mg), allowing a comparison between different drugs and doses [4].…”