Demographic and Neuropsychiatric Factors Associated With Off-label Medication Use in Frontotemporal Dementia and Alzheimer’s Disease

Abstract

Objectives Off-label medication use for treating cognitive impairments and neuropsychiatric symptoms occurs in frontotemporal dementia (FTD) and Alzheimer’s disease (AD). We compared use of cognitive and psychiatric medications in FTD and AD and evaluated the relationship between neuropsychiatric symptoms and medication use. Methods Cognitive and psychiatric medication use, demographic variables and Neuropsychiatric Inventory (NPI) subscale symptoms were obtained from the National Alzheimer’s Coordinating Center Uniform Data Set (n=3958, 8.1% FTD). Bivariate statistics and logistic regressions were calculated to evaluate which demographic or NPI subscale symptoms predicted medication use. Results Although cognitive medication was used more commonly in AD (78%) it was also commonly used off-label in FTD (56%). Psychiatric medications were in greater use in FTD than AD (68 vs. 45%, respectively, p<0.001). In FTD, cognitive medication use was associated with elevated NPI elation scores and psychiatric medication use was associated with history of prior psychiatric disease. In AD, demographic variables (white, longer disease duration, higher education, more severe disease or being male) were most predictive of cognitive medication use while having psychiatric disease, being white, having longer disease duration, being younger, greater disease severity, being disinhibited or anxious were associated with psychiatric medication use. Off-label antipsychotics were used in 4.7% of patients with AD and 10% of patients with FTD. Conclusions Our results revealed significant off-label medication use in both FTD and AD. A notable finding from this study was the lack of consistent relationships between medication use and neuropsychiatric symptoms across the two illnesses.

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

“…In the present study, several factors significantly associated with AP use have been identified. One of the main factors was cognitive decline as measured here with the MMSE score and known to be associated with BPSD and with an increased risk of AP prescribing [ 8 , 25 , 35 ]. Younger age, male gender and institutionalization are also risk factors associated with increased AP prescribing [ 25 ].…”

A systematic review of the prevalence of depression, anxiety, and apathy in frontotemporal dementia, atypical and young-onset Alzheimer’s disease, and inherited dementia

“…Studies of bv-FTD reported a high prevalence of apathy symptoms (Lopez et al, 1996), with a range of 73-100% across seven studies (Chow et al, 2009;Chow, Miller, Boone, Mishkin, & Cummings, 2002;Diehl-Schmid, Pohl, Perneczky, Förstl, & Kurz, 2006;Liu et al, 2004;Perri, Monaco, Fadda, Caltagirone, & Carlesimo, 2014;Rosen et al, 2002;Tartaglia et al, 2014). Diehl-Schmid et al (2006) stratified by CDR score, with 91% of mild patients (CDR score of 1) and 100% of moderate/severe patients (CDR score of 2 or 3) reporting symptoms of apathy.…”

Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia

“…However, there was a long interval between the assessments and death in some of their patients (range of 1 month to 2 years between the last NPS assessment and death). Moreover, the NPS were not measured using an NPI questionnaire or interview, but instead based on medication usage, which may not accurately reflect the NPS since these medications are often used off-label for other symptoms [40]. …”