Real-World Treatment Patterns and Characteristics Among Patients with Agitation and Dementia in the United States: Findings from a Large, Observational, Retrospective Chart Review

Aigbogun, Myrlene Sanon; Cloutier, Martin; Gauthier‐Loiselle, Marjolaine; Guérin, Annie; Ladouceur, Martin; Baker, Ross A.; Grundman, Michael; Duffy, Ruth A.; Hartry, Ann; Gwin, Keva; Fillit, Howard

doi:10.3233/jad-200127

Cited by 12 publications

(9 citation statements)

References 35 publications

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“…Antipsychotic use did not increase in parallel with the severity of cognitive impairment. Antipsychotic use was significantly associated with moderately severe dementia (as opposed to mild or severe) in all three papers that reported on this [ 48 , 52 , 57 ]. One paper found no association between cognition (measured by the Mini-Mental State Examination) and antipsychotic use; however, Mini-Mental State Examination scores were not categorized as mild, moderate, or severe, and a cumulative value was used, which may have influenced the findings [ 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…All the papers above were rated as moderate risk of bias apart from one [ 48 ], which was rated a low risk of bias. Three of the studies were cross-sectional in nature [ 42 , 48 , 52 ] and two were longitudinal cohorts of up to 1 year follow-up [ 57 , 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…Orsel et al [ 9 ] reported a prevalence of 18.3% of two or more psychotropic agents prescribed concomitantly, while Maust et al [ 50 ] found that 13.9% were prescribed three or more central nervous system-active medications for at least 30 days. The use of three antipsychotic agents was reported in 3.9% of the sample in a study by Aigbogun et al [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

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

Loftus,

Wand,

Breen

et al. 2023

Drugs Aging

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Background There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care. Objectives To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community. Methods This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010–2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle–Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data. Results The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness. Conclusions While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur. PROSPERO Registration Number CRD42021286322. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01070-0.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

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

Loftus,

Wand,

Breen

et al. 2023

Drugs Aging

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“…The last paper was published by Aigbogun et al 2020. This nature of this study is a retrospective observational medical history chart review.…”

Section: Sedation and Risk Of Fallsmentioning

confidence: 99%

New Hope for Behavioural and Psychological Symptoms in Dementia (BPSD): A Narrative Review of Clinical Studies Conducted in the Symptomatic Treatments for Agitation and Psychosis Episodes in Alzheimer’s Disease/Dementia

Qasim¹,

Donna²

2022

Preprint

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Background: The psychomotor agitation of the BPSD is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferable choice of treatment. But which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from RCTs and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who had taken agitation treatments. Assessing the efficacy of antidepressants and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This narrative review includes RCTs and retrospective studies that were comparing one or more active ingredient medications with another or with a placebo, along with sys-tematic reviews comparing antidepressants with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies extracted by searching accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Quality of evidence: The quality of systematic reviews was judged against AMSTAR score, and RCTs were judged according to CONSORT checklist for RCT protocols. Conclusion: There are still few studies of serotonin targeting treatment of agitation in BPSD. The SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. This review also illustrates brexpiprazole as a target of multimodal neurotransmitters such as dopamine, serotonin, and norepinephrine; and dextromethorphan, OR dextromethorphan associated with bupropion or quinidine as a blockade of NMDA receptors. The outcome of this review suggests that further studies involving more dementia/Alzheimer’s participants should be conducted. Future studies are required also to assess the long-term safety and efficacy of SSRI, brexpiprazole, dextromethorphan treatments for agitation in BPSD.

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Brexpiprazole for the Treatment of Agitation in Alzheimer Dementia

Lee,

Slomkowski,

Hefting

et al. 2023

JAMA Neurol

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ImportanceAgitation is a prevalent, distressing, and burdensome manifestation of Alzheimer dementia in need of an efficacious, safe, and well-tolerated treatment.ObjectiveTo confirm the efficacy, safety, and tolerability of brexpiprazole in patients with agitation in Alzheimer dementia.Design, Setting, and ParticipantsThis randomized clinical trial was a 12-week, double-blind, placebo-controlled, fixed-dose, parallel-arm trial that ran from May 2018 to June 2022 at 123 clinical trial sites in Europe and the United States. Participants included patients with agitation in Alzheimer dementia in a care facility or community-based setting. Stable Alzheimer disease medications were permitted.InterventionsIn this 2-arm trial, patients were randomized to receive oral brexpiprazole or placebo (2:1 ratio) for 12 weeks. Within the brexpiprazole arm, patients were further randomized to receive fixed doses of 2 mg/d or 3 mg/d in a 1:2 ratio.Main Outcomes and MeasuresThe primary end point was change in Cohen-Mansfield Agitation Inventory total score (which measures the frequency of 29 agitated behaviors) from baseline to week 12 for brexpiprazole, 2 or 3 mg, vs placebo. Safety was assessed by standard measures, including treatment-emergent adverse events.ResultsA total of 345 patients were randomized to receive brexpiprazole (n = 228) or placebo (n = 117); completion rates were 198 (86.8%) for brexpiprazole and 104 (88.9%) for placebo. Mean (SD) age was 74.0 (7.5) years, and 195 of 345 patients were female (56.5%). Patients receiving brexpiprazole, 2 or 3 mg (n = 225), demonstrated statistically significantly greater improvement than those taking placebo (n = 116) in Cohen-Mansfield Agitation Inventory total score from baseline to week 12 (brexpiprazole baseline, 80.6, mean change, −22.6; placebo baseline, 79.2, mean change, −17.3; least-squares mean difference, −5.32; 95% CI, −8.77 to −1.87; P = .003; Cohen d effect size, 0.35). No treatment-emergent adverse events had an incidence of 5% or more with brexpiprazole and greater incidence than placebo. The proportion of patients who discontinued because of adverse events was 12 of 226 (5.3%) for brexpiprazole and 5 of 116 (4.3%) for placebo.Conclusions and RelevanceIn this study, patients with Alzheimer dementia who took brexpiprazole, 2 or 3 mg, showed a statistically significant improvement vs placebo in agitation over 12 weeks. Brexpiprazole was generally well tolerated over 12 weeks in this vulnerable patient population.Trial RegistrationClinicalTrials.gov Identifier: NCT03548584

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Real-World Treatment Patterns and Characteristics Among Patients with Agitation and Dementia in the United States: Findings from a Large, Observational, Retrospective Chart Review

Cited by 12 publications

References 35 publications

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

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

New Hope for Behavioural and Psychological Symptoms in Dementia (BPSD): A Narrative Review of Clinical Studies Conducted in the Symptomatic Treatments for Agitation and Psychosis Episodes in Alzheimer’s Disease/Dementia

Brexpiprazole for the Treatment of Agitation in Alzheimer Dementia

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