Medication Use for Comorbidities in People with Alzheimer's Disease: An Australian Population‐Based Study

Abstract

BACKGROUND People with Alzheimer's disease (AD) often have multimorbidity and take multiple medi-cines. Yet few studies have examined medicine utilization for comorbidities comparing people with and without AD. OBJECTIVE The aim was to investigate the patterns of medication use for comorbidities in people with and without AD. METHODS An Australian population-based study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims data. People with AD were defined as those dispensed medicines for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioral and psychological symptoms of dementia) between January 1, 2005, and December 31, 2015, who were aged 65 years or older and alive at the end of 2016. An age-and gender-matched comparison cohort (5:1) of people without AD were identified. Medication use for comorbidities was identified using the validated comorbidity index, Rx-Risk-V. A v 2 test was used to compare differences in the pattern of medicine use between the two groups. RESULTS A total of 8280 people with AD and 41,400 comparisons without AD were included; 63.4% were female and the median age was 82 years. The median number of comorbidities was greater in people with AD {median [interquartile range (IQR)]: 5 [3-7]} than the comparison group (median [IQR]: 4 [3-6], p<0.0001). Medications for depression, pain (treated with opioid analgesics), anxiety, diabetes, hyperthyroidism, epilepsy, Parkinson's disease, and antipsychotics were used significantly more commonly in people with AD than in those without dementia. Medications for cardiac conditions, pain (treated with anti-inflammatory medications), chronic airways disease, gout, glaucoma, renal disease, benign prostatic hyperplasia, cancer, and steroid-responsive conditions were used significantly less commonly among people with AD than the comparison group. CONCLUSIONS This study highlighted significant variations in medication use for comorbidities between people with and without AD. Future studies should evaluate the reasons for the disparity in medicine utilization for comorbidities in people with AD.

Comprehensive Management of Daily Living Activities, behavioral and Psychological Symptoms, and Cognitive Function in Patients with Alzheimer's Disease: A Chinese Consensus on the Comprehensive Management of Alzheimer's Disease

“…For the elderly, comorbidities are common in AD patients (Table 4). [51][52][53] More studies have shown that some comorbidities are not only risk factors but also might be associated with the development of AD and affect the choice of anti-dementia medication [53,54]. Appropriate instructions on comorbidity management are important for comprehensive management.…”

Prevalence of oral anticoagulant use among people with and without Alzheimer’s disease

“…Previous studies have demonstrated that people with cognitive disorders are less likely to use oral anticoagulants [ 19 , 21 ] and discontinuation often occurs at dementia diagnosis [ 20 ]. However, as development of cognitive disorder is a long process, so investigation of changes in drug utilization prior to diagnosis is relevant.…”

“…In a study on US Veteran’s Affairs database, restricted to people aged 65 and older and with atrial fibrillation, only 16% of warfarin users persisted use after dementia diagnosis, compared to 96.7% of those without dementia [ 20 ]. In an Australian population-based study people with AD were less likely to use anticoagulant than those without AD (13% vs. 18%) [ 21 ]. As these previous studies have investigated oral anticoagulant use in people who already had AD or other cognitive disorders, it is unknown whether the differences occur already before diagnosis and how they evolve over time.…”

Diabetes treatment deintensification in Australians with dementia compared to the general population: A national cohort study

“…Supply of risperidone for behavioral disturbances in dementia was identified by the indication‐specific PBS item codes (Table S1). 23 Risperidone prescriptions for other psychiatric indications that use different PBS item codes were not included.…”