Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

Abstract

Objectives: The aim of this study was to describe the course of psychotropic drug use in people with young-onset dementia and to explore possible associations with age, sex, dementia severity, dementia subtype and neuropsychiatric symptoms. Methods: Psychotropic drug use was studied in 198 community-dwelling persons participating in the Needs in Young-onset Dementia study. Data about psychotropic drug use were retrieved at baseline, as well as at 6, 12, 18 and 24 months and was classified into five groups (antiepileptics, antipsychotics, anxiolytics, hypnotics/sedatives and antidepressants) and quantified as 'present' or 'absent'. Generalized Estimating Equation modeling and chi-square tests were used to study associations between the determinants and psychotropic drug use. Results: There was a statistically significant increase in the prevalence of psychotropic drug use from 52.3% to 62.6% during the course of the study. Almost three-quarters (72.4%) of the participants were treated with any psychotropic drug during the study, and more than one-third (37.4%) received psychotropic drugs continuously. Antipsychotics were used continuously in more than 10% of the participants and antidepressants in more than 25%. Increasing age was positively associated (p ¼ .018) with psychotropic drug use at baseline, while apathy symptoms were negatively associated (p ¼ .018). Conclusions: Despite the recommendations of various guidelines, the prolonged use of psychotropic drugs in community-dwelling people with young-onset dementia is high. Therefore, more attention is needed to timely evaluate psychotropic drug use and the introduction of self-management programs for caregivers should be encouraged to support caregivers in dealing with the neuropsychiatric symptoms caused by the dementia.

Factors Associated with Psychotropic Medication Use in People Living with Dementia in the Community: A Systematic Review and Meta-Analysis

“…Male sex was associated with prescriptions of antipsychotics Polypharmacy was associated with female sex Sex associations were identified from 4 years prior to diagnosis Moderate Eichler et al (2015) [ 52 ] 243 Cross-sectional analysis of randomized controlled intervention study (DelpHi-MV) Antipsychotics Alzheimer’s Dementia DemTect < 9 Included psychiatric comorbidity No respite 79.6 years (5.4) 61% 12 month follow-up Associations with antipsychotic use included having moderate cognitive impairment (defined in study as MMSE 10-19), functional impairment and treatment by a specialist. Moderate Gerritsen et al (2021) [ 25 ] 198 Longitudinal cohort study Antipsychotics Antidepressants Anxiolytics/hypnotics Antiepileptics Alzheimer’s disease, fronto-temporal dementia, vascular dementia, and mixed dementia Mckhann criteria, NIND-AIREN criteria, FTD clinical consensus criteria. Included psychiatric comorbidity Excluded known diagnosis of epilepsy No respite 60.9 years (5.5) 46.9% 2-year follow-up Use of any psychotropic medication was associated with increasing age and apathy.…”

“…The participants’ ages ranged from 37 to 100 years. One study specifically focused on people with younger onset dementia (ages < 65 years) [ 25 ], and one specifically on males [ 26 ].…”

“…The majority of these papers (5/6) were retrospective longitudinal cohort studies of good quality and low risk of bias. One paper [ 25 ], a prospective longitudinal cohort study of good quality and low risk of bias, found no sex difference in their population of young onset people with dementia. Of the four papers that reported the use of opioids, all identified a significant difference in favor of females [ 8 , 27 , 28 , 32 ].…”

“…Five of the eight studies were good quality and low risk of bias. The two remaining papers found no difference between males and females [ 25 , 38 ]. Of these two papers, one represented a unique younger onset dementia population [ 25 ], while the other investigated carer and care recipient factors rather than sex, which may have influenced the outcomes of this finding [ 38 ].…”

“…Antipsychotic use was most closely associated with Neuropsychiatric Inventory (NPI) scores. Six of eight studies demonstrated a significant association between increasing NPI scores and antipsychotic use [ 26 , 42 , 48 , 54 , 57 , 59 ], while two did not [ 25 , 58 ]. No consistent trend was identified regarding NPI scores and antidepressant or anxiolytic/hypnotic medication use.…”